INTERVERTEBRAL DISC SYNDROME

MATTHEW W. BLACKWELDER · 2025 · Case ID: A25110751

MIXED

Summary

The veteran, who served from September 1968 to April 1969, appeals the denial of higher ratings for his low back condition, left and right lower extremity radiculopathy, low back scars, and service connection for bowel/bladder incontinence secondary to his service-connected low back condition. The Board granted a 40 percent rating for the low back condition from June 18, 2018, based on flexion limited to 15 degrees with pain, and an estimated 10 degrees during flare-ups, finding this met the criteria for the 40 percent evaluation, particularly when considering the Veteran's use of pain medication and injections. However, the Board denied a higher rating, finding no unfavorable ankylosis or sufficient incapacitating episodes requiring prescribed bedrest. For left lower extremity radiculopathy, the Board granted a 60 percent rating from April 19, 2018, citing marked muscular atrophy in the left calf, severe constant pain, instability, decreased sensation, trophic changes, and use of assistive devices, which approximated severe incomplete paralysis. An 80 percent rating was denied as the evidence did not support complete paralysis. For right lower extremity radiculopathy, the Board denied a rating higher than 40 percent, finding the symptoms, while present, did not meet the criteria for severe incomplete paralysis, particularly lacking marked muscular atrophy. The scar claims were denied as they did not meet the criteria for area or instability/pain. Service connection for bowel/bladder incontinence secondary to the low back condition was denied, as the Board found the incontinence was more likely due to metastatic prostate cancer with spinal cord compression, not the service-connected back or radicular conditions.

Rationale

Forward flexion limited to 15 degrees with pain; Estimated 10 degrees flexion during flare-ups; Consideration of pain medication and injections

Special Benefit

NO SPECIAL BENEFIT

Diagnostic Code

5242

Docket No.

250310-531221

Full Decision Text

Citation Nr: A25110751
Decision Date: 12/30/25 Archive Date: 12/30/25

DOCKET NO. 250310-531221
DATE: December 30, 2025

ORDER

A 40 percent rating, but no higher, is for the Veteran's low back condition, is granted from June 18, 2018.

A rating in excess of 40 percent for the Veteran's low back condition is denied.

A 60 percent rating for left lower extremity radiculopathy of the sciatic nerve is granted, subject to the laws and regulations governing the award of monetary benefits.

A rating in excess of 60 percent for left lower extremity radiculopathy of the sciatic nerve, is denied.

A rating in excess of 40 percent for right lower extremity radiculopathy of the sciatic nerve radiculopathy is denied.

A compensable rating for the Veteran's low back scar from June 18, 2018, is denied.

A rating in excess of 10 percent for the Veteran's low back scar is denied.

Service connection for a separate rating for bowel/bladder incontinence, as secondary to the Veteran's service-connected low back condition, is denied.

FINDINGS OF FACT

1. From June 18, 2018, the Veteran's low back condition resulted in forward flexion of the thoracolumbar spine that was functionally limited to 30 degrees or less.

2. During the period on appeal, the Veteran's low back condition did not manifest in unfavorable ankylosis of the entire thoracolumbar spine, unfavorable ankylosis of the entire spine, or IVDS with incapacitating episodes having a total duration of at least six weeks during the past 12 months.

3. The Veteran has severe incomplete paralysis of the sciatic nerve in his left lower extremity.

4. Throughout the appeal period, the Veteran has not demonstrated complete paralysis due to radiculopathy of the sciatic nerve in the left lower extremity.

5. The Veteran had not demonstrated severe incomplete paralysis of the sciatic nerve in the right lower extremity.

6. The Veteran's low back scars have not been shown to be at least 144 square inches (929 sq. cm.) or greater.

7. The Veteran does not have three or four low back scars that are unstable or painful.

8. The evidence is against a finding that the Veteran's bowel/bladder incontinence was caused by the Veteran's service or service-connected low back and radicular conditions.

CONCLUSIONS OF LAW

1. The criteria for a 40 percent disability rating for a low back condition have been met from June 8, 2018. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.102, 3.159, 4.71a, Diagnostic Code (DC) 5242.

2. The criteria for a disability rating in excess of 40 percent for the low back disability have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.102, 3.159, 4.71a, DC 5242.

3. The criteria for a 60 percent rating for left lower extremity radiculopathy of the sciatic nerve have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, DC 8520.

4. The criteria for a rating in excess of 60 percent rating for left lower extremity radiculopathy of the sciatic nerve have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, DC 8520.

5. The criteria for a rating in excess of 40 percent for right lower extremity radiculopathy of the sciatic nerve have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, DC 8520.

6. The criteria for a compensable rating for a low back scar, prior to June 18, 2018, have not been met. 38 U.S.C. §§ 1155, 5107; 38C.F.R. §§ 4.1, 4.2, 4.7, 4.118; DC 7802.

7. The criteria for a rating in excess of 10 percent for a low back scar have not been met. 38 U.S.C.
. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, DC 8520.

6. The criteria for a compensable rating for a low back scar, prior to June 18, 2018, have not been met. 38 U.S.C. §§ 1155, 5107; 38C.F.R. §§ 4.1, 4.2, 4.7, 4.118; DC 7802.

7. The criteria for a rating in excess of 10 percent for a low back scar have not been met. 38 U.S.C. §§ 1155, 5107; 38C.F.R. §§ 4.1, 4.2, 4.7, 4.118; DC 7804.

8. The criteria for service connection for bowel/bladder incontinence have not been met. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.304, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran had active service from September 1968 to April 1969. In connection with this appeal, the Veteran testified at three separate Board hearings, most recently in August 2025. Transcripts of all three hearings are of record.

This matter stemmed from a January 2025 Supplemental Statement of the Case (SSOC) that denied higher ratings for the Veteran's low back condition, bilateral lower extremity radiculopathy, low back scars, and service connection for bowel and bladder impairment.

The Veteran appealed the January 2025 SSOC to the Board by filing a VA Form 10182 wherein he selected the hearing docket within the Veterans Appeals Modernization Act (AMA) review system. Therefore, the Board may only consider the evidence of record at the time of the January 2025 SSOC, at the Board hearing, or within 90 days of the Board hearing. 38?C.F.R. §?20.303. The Board cannot consider evidence submitted during a period after the AOJ issued the decision on appeal. Id.

Increased Rating

Low Back

The Veteran's low back condition is currently rated at 10 percent from November 8, 2010, 20 percent from September 15, 2014, 20 percent from June 18, 2018, and 40 percent from August 30, 2018.

It is of note that the rating criteria for evaluating musculoskeletal disabilities under 38?C.F.R. §?4.71a were amended effective February 7, 2021. 85 Fed. Reg. 230 (Nov. 30, 2020). However, the General Rating Formula for Diseases and Injuries of the Spine code and Formula for Rating Intervertebral Disc Syndrome (IVDS) did not change.

A back disability may be rated under either the General Rating Formula for Diseases and Injuries of the Spine, or the Formula for Rating IVDS, whichever method results in the higher evaluation when all disabilities are combined. 38 C.F.R. §?4.71a. The General Rating Formula for Diseases and Injuries of the Spine provides that a 20 percent evaluation is assigned when forward flexion of the thoracolumbar spine is greater than 30 degrees, but not greater than 60 degrees, or there is muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis. A 40 percent evaluation is assigned when forward flexion of the thoracolumbar spine is 30 degrees or less or when there is favorable ankylosis of the entire thoracolumbar spine. A 50 percent evaluation is assigned if there is unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent evaluation is assigned for unfavorable ankylosis of the entire spine. 38?C.F.R. §?4.71a, General Rating Formula for Diseases and Injuries of the Spine.

Normal ranges of motion of the thoracolumbar spine are flexion from 0 to 90 degrees, extension from 0 to 30 degrees, lateral flexion from 0 to 30 degrees, and lateral rotation from 0 to 30 degrees. 38?C.F.R. §?4.71, Plate V.

Under the Formula for Rating IVDS, a 10 percent evaluation is assigned for IVDS with incapacitating episodes having a total duration of at least one week but less than two weeks during the past 12 months. A 20 percent evaluation is assigned for IVDS with incapacitating episodes having a total duration of at least two weeks but less than four weeks during the past 12 months. A 40 percent evaluation is assigned for IVDS with incapacitating episodes having a total duration of at least four weeks but less than six weeks during the past 12 months. The maximum 60 percent evaluation is assigned for IVDS with incapacitating episodes having a total duration of at least six weeks during the past 12 months.

It is also noted that the period on appeal begins June 18, 2018 (or one year prior if it is factually ascertainable that an increase in the Veteran's condition occurred during that time) and ends on January 16, 2025. Therefore, the Board will address whether a rating in excess of 20 percent is warranted from June 18, 2018, and whether a rating in excess of 40 percent is warranted from August 30, 2018.

The Veteran was afforded a VA examination in July 2018 and reported experiencing flareups that led to difficulty with prolonged sitting, standing, walking, stooping, and bending. The VA examiner noted his functional loss was decreased range of motion and pain with most activities. Upon examination, the Veteran's forward flexion was to 40 degrees with pain. He was able to perform repetitive use testing with at least three repetitions without loss of range of motion and was also examined immediately after repeated use over time and during a flare up. There was no guarding/muscle spasm, atrophy, ankylosis, radiculopathy, other neurologic abnormalities, IVDS, or use of assistive devices. Muscle strength and reflex testing was normal. The VA examiner noted objective evidence of pain on passive range of motion and non-weight bearing.

The Veteran was afforded another VA examination in September 2018. He reported experiencing flareups and a severe shooting pain starting on the inside of his left leg from groin to ankle, to the bottom of his foot. Functional loss was described as stooping and leaning to the side (feeling like one leg was shorter), which prevented movement. Upon examination, forward flexion was to 15 degrees with pain, and there was also pain with weight bearing. The Veteran was able to perform repetitive use testing with at least three repetitions, and his forward flexion was to 10 degrees with pain. He was examined after repeated use over time, and his forward flexion (with pain) was to 10 degrees. He was not examined during a flare up, but the VA examiner estimated his forward flexion to be limited to 10 degrees during flare-ups. There were guarding/muscle spasms not resulting in abnormal gait or spine contour, as well as disturbances of locomotion, and interference with standing and sitting. Muscle strength and sensation testing was normal, and there was no ankylosis or other neurologic abnormalities. The VA examiner noted there was atrophy, and that his right calf (normal) measured 37cm, and his left calf measured 35cm. The Veteran had absent reflexes (knee/ankle), and radiculopathy. There were no radicular symptoms in his right lower extremity, but severe constant pain and paresthesia and/or dysesthesias, and moderate intermittent pain and numbness in his left lower extremity, with moderate sciatic nerve involvement. The Veteran had IVDS without episodes of prescribed bedrest and reported he regularly used a cane. There was pain with passive range of motion and on non-weight bearing.

The Veteran was afforded another VA examination in September 2019 and reported increased numbness, tingling, pain and weakness in his left lower extremity. The Veteran also reported experiencing flareups with increased activity, walking, stooping, and standing, and his functional loss included decreased walking and standing endurance. Upon examination, the Veteran's forward flexion was to 60 degrees with pain. The Veteran was able to perform repetitive use testing with at least three repetitions without loss of range of motion. The VA examiner estimated that the Veteran's forward flexion after repeated use over time and during a flareup was to 60 degrees with pain, and that lack of endurance (repeated use) and pain (flareup) caused functional loss. There was no guarding/spasm, but the VA examiner noted that disturbance of locomotion, and interference with sitting and standing contributed to the Veteran's disability, in that he experienced pain and had to frequently change positions. Muscle strength was normal, and there was no atrophy, ankylosis, IVDS, or other neurologic abnormalities. The Veteran had normal reflexes in his right lower extremity, hypoactive reflexes in his left lower extremity, normal sensations in his right lower extremity, and decreased sensation in his left thigh/knee, lower leg/ankle, and foot/toes. There was radiculopathy in the Veteran's left lower extremity only, which resulted in moderate constant pain, paresthesia and/or dysesthesias and numbness, and severe intermittent pain with moderate sciatic nerve involvement. The Veteran reported using a cane regularly and endorsed frequent tripping. There was no pain with weight bearing, and passive range of motion was the same as active range of motion.

The Veteran was afforded another VA examination in November 2022 and reported that his pain got progressively worse. He reported worsening flareups that were instigated by sitting, lying, or standing for too long, and that he took pain medication but that it did not completely relieve his symptoms. He stated that at the examination, his current pain level was 8/10, and that he had issues with sleep due to pain/repositioning. Upon examination, forward flexion was to 40 degrees with pain and passive range of motion was the same. The Veteran was able to perform repetitive use testing with at least three repetitions without loss of range of motion. He was not examined after repeated use over time or during a flareup and the VA examiner stated it was not medically possible to provide range of motion estimations without speculation. There was no crepitus, ankylosis, atrophy, or use of assistive devices, and the Veteran had normal strength, reflexes and sensations. There was evidence of radiculopathy, and the VA examiner noted severe constant pain, intermittent pain, paresthesia and/or dysesthesias, and numbness bilaterally with sciatic nerve involvement, but no other neurologic symptoms. The Veteran had IVDS without episodes of bedrest prescribed by a physician. The VA examiner stated that the Veteran's bilateral radiculopathy first started 11/4/22, and that the Veteran had issues with falling, weakness in legs, pain in his back, problems sleeping, and a decrease in mobility.

The Veteran was afforded another VA examination in November 2024 and noted progressive worsening of his back pain from 2017 to the present. He reported that he was currently taking oxycontin for back pain and attempted stretching, and that decreased range of motion caused difficulty with bending, stooping, kneeling, climbing or lifting. He endorsed severe flareups that occurred 5-6 times a week, lasted one day and were precipitated by increased activity, frequent lifting, laying down, and alleviated by rest and pain medications. Upon examination, flexion was to 40 degrees with pain, there was pain with weight bearing, and active range of motion was the same as passive range of motion. The Veteran was able to perform repetitive use testing with at least three repetitions without additional loss of range of motion. He was not examined after repeated used over time or during a flareup, but his estimated flexion was to 35 degrees and 30 degrees respectively. The VA examiner noted tenderness that did not result in an abnormal gait or spinal contour. Muscle strength was normal, and there was no atrophy, crepitus, IVDS, ankylosis or use of assistive devices. The Veteran had radiculopathy (sciatic nerve involvement) with moderate constant pain, intermittent pain, paresthesia/dyschesia, and numbness bilaterally, but no other signs of radiculopathy. He also had decreased sensations bilaterally in his thigh/knee, lower leg/ankle, and feet/to
He was not examined after repeated used over time or during a flareup, but his estimated flexion was to 35 degrees and 30 degrees respectively. The VA examiner noted tenderness that did not result in an abnormal gait or spinal contour. Muscle strength was normal, and there was no atrophy, crepitus, IVDS, ankylosis or use of assistive devices. The Veteran had radiculopathy (sciatic nerve involvement) with moderate constant pain, intermittent pain, paresthesia/dyschesia, and numbness bilaterally, but no other signs of radiculopathy. He also had decreased sensations bilaterally in his thigh/knee, lower leg/ankle, and feet/toes. He was unable to perform a straight leg test.

A range of motion opinion was obtained in November 2024 and the VA examiner stated that the Veteran's statements indicated he experienced more frequent flareups several times a week for several years, and that he could reasonably estimate 3-4 flareups a week, of moderate severity, that worsened with repetitive motion or frequent use prior to 8/30/18. He stated that per his best estimate, the Veteran's flareups would constitute an additional loss of about 5 degrees in terms of range of motion with an additional 5-degree loss with repetitive motion prior to 8/30/2018. He also noted the Veteran's back condition had never manifested in ankylosis or its functional equivalent.

The Veteran's medical records do not show a worsening of symptoms beyond what was shown at the various VA examinations. His private treatment records show he underwent a series of lumbar injections in 2019 due to back pain. In October 2020, Dr. M.F. submitted a statement, noting the Veteran had constant low back pain since his discectomy, that he had an epidural steroid injection without relief, difficulty standing for any length of time, gait changes, and more limited range of motion since his last rating. In a November 2020 vocational examination, the Veteran reported his back would cause so much pain, he would be bedridden for 3-9 days.

The Veteran submitted a statement in May 2018, stating that he could not bend forward, side to side, or back anymore.

At the July 2020 Board hearing, the Veteran reported that he would have incapacitating episodes of pain, where he had to lay down for several days. He stated it happened at least 3-4 times a year, that if he moved, the pain was excruciating, and that he was not prescribed bedrest.

At the August 2025 Board hearing, the Veteran reported he underwent back surgery in May 2018 and that after surgery he could not bend over and touch his toes, and that he did not have a lot of ability to bend forward.

Analysis

As stated above, the Veteran's low back condition is rated at 20 percent from June 18, 2018, and 40 percent from August 30, 2018.

The Board finds that a 40 percent rating is warranted from June 18, 2018. At the September 2018 VA examination, the Veteran's flexion was shown to be to 15 degrees with pain, and an estimated 10 degrees during a flareup or after repeated use over time. Additionally, the November 2024 VA examiner opined that the Veteran's flareups would result in an additional loss of five degrees prior to August 2018, which would make his estimated flexion during a flareup at that time to be to 35 degrees. As the Veteran's September 2018 VA examination showed flexion to be less than 30 degrees, the Board finds it reasonable to conclude that the Veteran was experiencing a loss of flexion that was functionally limited to less than 30 degrees the majority of the time from the date of claim due to his reported flareups (June 2018), particularly in light of the Veteran's use of injections and pain medication to treat his back. The Board is required to discount any ameliorative effects of medication, and when that is done, the range of motion measurements which did not necessarily meet the criteria for a 40 percent rating are found to be supportive of such a rating. Therefore, a 40 percent rating for the Veteran's low back is granted from June 18, 2018.

However, the Board does not find that a rating in excess of 40 percent for the Veteran's low back condition is warranted. As stated above, in order to be assigned a 50 percent rating under DC 5242, the Veteran's low back symptoms must have manifested in unfavorable ankylosis of the entire thoracolumbar spine. Alternatively, if evaluated under the criteria for IVDS, in order to receive the maximum
of medication, and when that is done, the range of motion measurements which did not necessarily meet the criteria for a 40 percent rating are found to be supportive of such a rating. Therefore, a 40 percent rating for the Veteran's low back is granted from June 18, 2018.

However, the Board does not find that a rating in excess of 40 percent for the Veteran's low back condition is warranted. As stated above, in order to be assigned a 50 percent rating under DC 5242, the Veteran's low back symptoms must have manifested in unfavorable ankylosis of the entire thoracolumbar spine. Alternatively, if evaluated under the criteria for IVDS, in order to receive the maximum 60 percent rating, the Veteran must have had incapacitating episodes having a total duration of at least six weeks during the past 12 months. Note 1 of the regulations state that an incapacitating episode includes bed rest prescribed by a physician.

The Veteran's records, to include the November 2024 VA examiner's opinion, do not show that he experienced unfavorable ankylosis of the entire thoracolumbar or entire spine, or its functional equivalent.

The Veteran demonstrated that he was still able to move his back, despite pain. While he testified that he had trouble bending, stooping lifting, standing, and walking, he still always maintained functionality of his back.

Additionally, while the Veteran was found to have IVDS, and reported that he experienced incapacitating episodes where he had to lie down for extended periods of time, the Board does not find that this meets the rating criteria for a higher rating. The Veteran was never prescribed bed rest by a physician, which required by the VA regulations as part of the rating criteria for a higher rating under the General Rating Formula for Diseases and Injuries of the Spine.

Therefore, a rating in excess of 40 percent for the Veteran's low back condition is denied.

Radiculopathy

The Veteran's left lower extremity sciatic radiculopathy is currently rated at 10 percent from March 9, 2012, 20 percent from April 19, 2018, and 40 percent from November 4, 2022, under DC 8520. The Veteran's right lower extremity sciatic radiculopathy is currently rated at 40 percent from November 4, 2022, under DC 8520.

DC 8520 contemplates impairment of the sciatic nerve. Under DC 8520, a 10 percent rating is warranted for mild incomplete paralysis of the sciatic nerve. A 20 percent rating is warranted for moderate incomplete paralysis of the sciatic nerve. A 40 percent rating is warranted for moderately severe incomplete paralysis of the sciatic nerve. A 60 percent rating is warranted for severe incomplete paralysis of the sciatic nerve with marked muscular atrophy. The highest possible rating, 80 percent, is warranted for complete paralysis of the sciatic nerve, meaning the foot dangles and drops, no active movement possible of muscles below the knee, flexion of knee weakened or (very rarely) lost.

In rating diseases of the peripheral nerves, the term "incomplete paralysis" indicates a degree of lost or impaired function substantially less than the type of picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. 38?C.F.R. §?4.124a.

The words "mild," "moderate," and "severe" as used in the various Diagnostic Codes are not defined in the Rating Schedule. Regulations provide that ratings for peripheral neurological disorders are to be assigned based on the relative impairment of motor function, trophic changes, or sensory disturbance. 38 C.F.R. § 4.120. Consideration is also given for loss of reflexes, pain, and muscle atrophy. See 38 C.F.R. §§ 4.123, 4.124. It should also be noted that use of terminology such as "severe" by VA examiners and others, although an element of evidence to be considered by the Board, is not dispositive of an issue. All evidence must be evaluated in arriving at a decision regarding an increased rating. 38 C.F.R. §§ 4.2, 4.6. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. 38 C.F.R. § 4.124a.

Although the regulations do not specifically define the terms "mild," "moderate," and "severe," the regulations do provide useful guidance for comparative analysis. The term "incomplete paralysis" indicates a degree of lost or impaired function that is
as "severe" by VA examiners and others, although an element of evidence to be considered by the Board, is not dispositive of an issue. All evidence must be evaluated in arriving at a decision regarding an increased rating. 38 C.F.R. §§ 4.2, 4.6. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. 38 C.F.R. § 4.124a.

Although the regulations do not specifically define the terms "mild," "moderate," and "severe," the regulations do provide useful guidance for comparative analysis. The term "incomplete paralysis" indicates a degree of lost or impaired function that is substantially less than that which is described in the criteria for an evaluation for complete paralysis of the nerve, whether the less than total paralysis is due to the varied level of the nerve lesion or to partial regeneration.

As noted above, the terms in the Diagnostic Code are not specifically defined. As such, it is incumbent upon the Board as finder of fact to define the undefined terms.

In this case, "mild" corresponds to slight symptoms sufficient to support the diagnosis, generally characterized by less persistent sensory deficits, or those affecting a small area, and or very minimal reflex or motor abnormalities.

"Moderate" corresponds to the maximum evaluation available for sensory-only impairment, characterized by symptoms described by the Veteran and considered significantly disabling medically, and/or involving a larger area in nerve distribution. Additionally, moderate can correspond to 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.

"Moderately severe" (only applicable for the sciatic nerve), is considered the maximum rating for sciatic nerve neuritis not characterized by the organic changes outlined in 38 C.F.R. §4.123 (loss of reflexes, muscle atrophy, sensory disturbances, and constant pain). It is expected that there be motor and/or reflex impairment at a grade reflecting a high level of limitation or disability.

"Severe" is characterized by 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 in severe longstanding neuropathy cases. Although severe incomplete paralysis cases should show findings substantially less than those for complete impairment of the nerve, the disability picture for severe incomplete paralysis may contain signs or symptoms that resemble some of those expected in cases of complete paralysis of the nerve.

The Veteran was afforded a VA examination for his back in July 2018, and the VA examiner noted there was no radiculopathy or other neurologic abnormalities, no use of assistive devices and muscle strength and reflex testing was normal.

The Veteran was afforded another VA examination in September 2018 for his back. The VA examiner noted disturbances of locomotion, interference with standing and sitting, and muscle strength and sensation testing was normal. Upon examination, the Veteran had atrophy in his calves. His right calf (normal) measured 37cm, and his left calf measured 35cm. There was radiculopathy in the Veteran's left lower extremity, resulting in severe constant pain and paresthesia and/or dysesthesias, moderate intermittent pain and numbness, and moderate sciatic nerve involvement. There were also absent reflexes in the Veteran's left knee and ankle. No other neurologic abnormalities were noted, and the Veteran reported regularly using a cane.

The Veteran was afforded another VA examination in September 2019 for his back, and the VA examiner noted disturbance of locomotion, and interference with standing/sitting contributed to his disability. Muscle strength was normal and there was no atrophy. The Veteran had normal reflexes and no radiculopathy in his right lower extremity. The Veteran was found to have radiculopathy in his left lower extremity, hypoactive reflexes, and decreased sensations in his left thigh/knee, lower leg/ankle and foot/toes. The Veteran's left lower extremity sciatic radiculopathy (moderate) resulted in moderate constant pain, paresthesia and/or dysesthesias and numbness, and severe intermittent pain, with no other neurologic abnormalities. The Veteran reported using a cane regularly.

The Veteran was afforded a peripheral nerves examination in November 2022 and reported intermittent radiculopathy down both legs, and sleep issues. He stated that he was in severe constant pain, intermittent pain, paresthesia and/or dysesthesia and numbness bilaterally. Muscle strength, sensations and reflexes were normal, there was no atrophy, or trophic changes, and his gait was normal. The VA examiner noted moderately severe incomplete paralysis of the sciatic nerve, and no use of assistive devices. The VA examiner also stated that intermittent pain/burning sensations in extremities impacted coordination of movements, that intermittent numbness/tingling altered functional capacity of extremities with basic movements and regular daily activities. The Veteran's sciatic radiculopathy resulted in bilateral severe constant pain, intermittent pain, paresthesia and/or dysesthesia, and numbness, there were no other neurologic symptoms, and no use of assistive devices. The VA examiner stated that the Veteran's bilateral radiculopathy first started 11/4/22, and that he had issues with falling, weakness in his legs, pain in back, problems sleeping, and that he could not sit/stand/walk for more than 10 minutes at a time.

The Veteran was afforded another VA examination in May 2024 and noted persistently worsening leg numbness, pain and tingling since onset, which caused difficulty with prolonged standing, walking, climbing stairs or ladders and lifting. He stated that he had fallen more over the last 1-2 years. The Veteran's moderately severe incomplete paralysis of the sciatic nerve (bilaterally) resulted in moderate constant pain, paresthesias and/or dysesthesias, and numbness. Muscle strength, and reflex testing was normal, and there was no atrophy, or use of assistive devices. The Veteran had trophic changes (smooth shiny skin bilaterally), and decreased sensations bilaterally in his thigh/knee, lower leg/ankle, and feet/toes. His gait was shown to be normal.

The Veteran was afforded another VA examination of his back in November 2024 for his back and the VA examiner noted normal muscle strength, no atrophy, decreased sensations (bilaterally) in his thigh/knee, lower leg/ankle, and foot toes. The Veteran's had bilateral sciatic nerve radiculopathy that resulted in moderate constant pain, intermittent pain, paresthesia/dysesthesias, and numbness. There were no other signs or radiculopathy.

The Veteran's medical records show that he experienced radiating pain down his leg in October 2018. In October 2020, the Veteran submitted an opinion from Dr. M.F. who noted the Veteran was on continuous analgesic medications due to his left lower extremity pain. At a November 2020 vocational assessment, the Veteran reported using a cane for balance and ambulation, that he had a history of tripping and falling due to not being able to feel his left foot, and that he felt sharp pain, tingling and numbness.

In January 2024, the Veteran submitted a statement that his legs and feet burned, that he felt radiating pain that felt akin to an electric shock with cramps below his knees and feet, and that this caused gait issues which led to falls.

In his June 2018 Supplemental Claim, the Veteran reported that he developed a limp from his left leg and foot pain, and that he was tripping much more than before.

At the July 2020 Board hearing, the Veteran testified that his left lower extremity pain kept him from sleeping, that it radiated down back through his groin and down his left side, and that it was like a throbbing/shocking pain. He stated he fell a lot and had a walking stick.

At the August 2023 Board hearing, the Veteran reported right leg pain for several years that radiated from his back. He endorsed numbness and frequent falls, and that he lost sensation in his right foot. He stated that his right foot dragged, and that his radiculopathy was affecting his feet (especially the left), in that he was falling/tripping frequently. The Veteran also reported having marked muscular atrophy, using a walker and a cane.

At the August 2025 Board hearing, the Veteran testified that he was told his left leg was thinner than his right, and that he could not feel his feet or lower extremities. He stated that he tripped often and felt shooting pains and hot flashes that impacted his sleep. He stated that his left leg was worse than his right, that he used a cane that helped with falls, that he tripped everyday, and that getting dressed was a challenge. He stated he also had injections in his right hip in the past. The Veteran reported losing muscle mass in his lower legs, that his feet were splayed and that he needed bigger shoes. He stated that he could feel pressure in his lower legs, but could not feel needle pokes, and that he was losing hair on his legs.

Analysis

Regarding the Veteran's left lower extremity radiculopathy, the Board finds that a 60 percent rating under DC 8250 is warranted from April 19, 2018, the date the Veteran reported worsening left lower extremity symptoms (see BVA decision, 2/15/2024).

At the September 2018 VA examination for his back, the Veteran was found to have marked muscular atrophy in his left calf. His right calf measured 37cm. and his left calf measured 35 cm. Furthermore, the Veteran's records throughout the period on appeal have shown that he has had significant impairment in his left lower extremity to include severe constant pain, instability, decreased sensations, trophic changes (shiny skin), and use of assistive devices. The Board finds that this symptomatology, along with the Veteran's marked muscular atrophy, warrants a higher rating. Therefore, a 60 percent rating for the Veteran's left lower extremity radiculopathy is granted.

However, an 80 percent rating is not warranted at this time. As stated above, an 80 percent rating under DC 8520, is warranted for complete paralysis of the sciatic nerve, meaning the foot dangles and drops, no active movement possible of muscles below the knee, flexion of knee weakened or (very rarely) lost. While the Veteran has testified that he was told he had foot drop, and that his left foot drags which causes tripping, the medical evidence does not support complete paralysis of the sciatic nerve.

At the various VA examinations, the Veteran's left lower extremity sciatic nerve radiculopathy was shown to be at worst, moderately severe, and his muscle strength was shown to be normal, and while somewhat limited, he still was able to move the muscle below the knee. Therefore, the Board finds that these symptoms most closely approximate a 60 percent rating under DC 8250.

Regarding the Veteran's right lower extremity radiculopathy, the Board finds that the first time the Veteran's condition manifested to compensable symptoms was at the November 2022 VA examination. Prior to that time, the Veteran's radiculopathy was limited to his left lower extremity. As stated above, in order to be assigned a 60 percent rating under DC 8520, the Veteran's radiculopathy must also have marked muscular atrophy. In this case, while the Veteran's right lower extremity sciatic radiculopathy resulted in symptoms such as tropic changes, pain and numbness, he has never been shown to have marked muscular atrophy. The Board also acknowledges the Veteran's reports that his right foot dangles. However, the medical evidence has not shown any diagnosed foot drop or dangle, and the Veteran still had mobility in his lower extremities. Overall, the Board finds that the Veteran's symptoms, especially without atrophy, suggest a disability picture indicative of moderately severe incomplete paralysis of his right lower extremity.

Therefore, a rating in excess of 40 percent for right lower extremity radiculopathy is denied.

Scar

The Veteran's scars are currently rated at noncompensable from June 18, 2018, under DC 7802, and at 10 percent from November 4, 2022, under DC 7804.

On August 13, 2018, the regulations regarding the rating criteria for skin disorders changed, however the regulations related to DC 7804 did not change. The Veteran filed a claim for service connection prior to August 13, 2018, and
Veteran's symptoms, especially without atrophy, suggest a disability picture indicative of moderately severe incomplete paralysis of his right lower extremity.

Therefore, a rating in excess of 40 percent for right lower extremity radiculopathy is denied.

Scar

The Veteran's scars are currently rated at noncompensable from June 18, 2018, under DC 7802, and at 10 percent from November 4, 2022, under DC 7804.

On August 13, 2018, the regulations regarding the rating criteria for skin disorders changed, however the regulations related to DC 7804 did not change. The Veteran filed a claim for service connection prior to August 13, 2018, and his appeal for an increased rating was pending on August 13, 2018. To that end, the Board must apply the pre-amended rating criteria for rating periods prior to the effective date of the amended regulations but may apply whichever criteria is more favorable to the Veteran for the periods after the revised regulations took effect. See Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003).

Under the pre-amended schedule, the maximum 10 percent rating under DC 7802 was assigned for burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are superficial and nonlinear: Area or areas of 144 square inches. Note one characterized a superficial scar as one not associated with underlying soft tissue damage. Note 2 stated that if multiple qualifying scars are present, or if a single qualifying scar affects more than one extremity, or a single qualifying scar affects one or more extremities and either the anterior portion or posterior portion of the trunk, or both, or a single qualifying scar affects both the anterior portion and the posterior portion of the trunk, assign a separate evaluation for each affected extremity based on the total area of the qualifying scars that affect that extremity, assign a separate evaluation based on the total area of the qualifying scars that affect the anterior portion of the trunk, and assign a separate evaluation based on the total area of the qualifying scars that affect the posterior portion of the trunk. The midaxillary line on each side separates the anterior and posterior portions of the trunk. Combine the separate evaluations under§?4.25. Qualifying scars are scars that are nonlinear, superficial, and are not located on the head, face, or neck.

Under the amended criteria for DC 7802, the maximin 10 percent rating is assigned for burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are not associated with underlying soft tissue damage: area or areas of 144 square inches (929 sq. cm.) or greater. Note (1): for the purposes of DC 7801 and 7802, the six (6) zones of the body are defined as each extremity, anterior trunk, and posterior trunk. The midaxillary line divides the anterior trunk from the posterior trunk. Note (2): A separate evaluation may be assigned for each affected zone of the body under this diagnostic code if there are multiple scars, or a single scar, affecting multiple zones of the body. Combine the separate evaluations under §4.25. Alternatively, if a higher evaluation would result from adding the areas affected from multiple zones of the body, a single evaluation may also be assigned under this diagnostic code.

As stated above, DC 7804 remained unchanged. A 10 percent rating is assigned for one or two scars that are unstable or painful. A 20 percent rating is assigned for three or four scars that are unstable or painful. A 30 percent rating is assigned for five or more scars hat are unstable or painful. Note (1): An unstable scar is one where, for any reason, there is frequent loss of covering of the skin over the scar. Note (2): If one or more scars are both unstable and painful, add 10 percent to the evaluation that is based on the total number of unstable or painful scars. Note (3): Scars evaluation under diagnostic codes 7800, 7801, 7802 or 7805 may also receive an evaluation under this diagnostic code when applicable.

The Veteran was afforded a VA exanimation in July 2018. The VA examiner noted a scar on the Veteran's lower back measuring 7cm x .1cm that was not painful or unstable.

The Veteran was afforded another VA examination in September 2018. The VA examiner noted a scar on the Veteran's lower back measuring 10cm x.1cm that was not painful or unstable.

The Veteran was afforded a VA exanimation in July 2018. The VA examiner noted a scar on the Veteran's lower back measuring 7cm x .1cm that was not painful or unstable.

The Veteran was afforded another VA examination in September 2018. The VA examiner noted a scar on the Veteran's lower back measuring 10cm x.1cm that was not painful or unstable.

The Veteran was afforded a VA examination in November 2022. The Veteran reported ongoing scar pain and issues with sleep. The VA examiner noted a scar on the Veteran's lower back measuring 18cm x 1cm that was not unstable. It was tender to palpitation, and not found to have underlying soft tissue damage with a total area of approximately 18cm squared. The VA examiner noted the functional impact was issues with bending, twisting and limited range of motion due to scar pain, and tenderness when anything rubbed against his scar.

At a November 2022 VA examination for the Veteran's peripheral nerves, the Veteran reported scar issues from a prior surgery that caused pain.

The Veteran was afforded another VA examination in September 2023. The VA examiner noted a scar on the Veteran's lower back measuring 14cm x .5cm that was not painful or unstable, and did not have underlying soft tissue damage.

The Veteran was afforded another VA examination in May 2024. The VA examiner noted a well healed scar, with no wound dehiscence on the Veteran's lower back measuring 14cm x .5cm that was not painful or unstable with no underlying soft tissue damage.

The Veteran was afforded another VA examination in August 2024. The VA examiner noted two scars on the Veteran's lower back measuring 19.12cm x .1cm and 4cm x .1cm which were both tender to palpation. The VA examiner stated that one scar was painful but not unstable, but did not state which one, and that there was no limitation of function.

The Veteran was afforded another VA exanimation in October 2024. The VA examiner noted a scar on the Veteran's lower back measuring 8cm x .25cm that was not painful or unstable, with no underlying soft tissue damage or limitation of function.

The Veteran's post service treatment records from May 2022 show that he had significant scar tissue at L4/L5 and L5/S1. The Veteran submitted a lay statement in January 2024 where he reported he had a smaller scar from 2008, and then had surgery again in May 2022 when he had a tumor removed. He stated that his scar was painful, that he was unable to reach for things, sit or lie for long periods, bend down, and that the scar was painful when it came into contact with his clothes. He noted that it felt like his scar felt stuck to his nerves.

At the July 2020 hearing, the Veteran testified that his scar was sensitive to the touch, and that it was itchy but not painful.

At the August 2023 Board hearing, the Veteran testified that he felt like his scar was catching when he moved, and felt like there was irritation at times.

At the December 2023 Board hearing, the Veteran testified that his scars were painful especially when he tried to sleep, and that he had a big and small scar that he could feel with certain movements (rubbing, lying or turning).

At the August 2025 Board hearing, the Veteran testified that he had two scars and had a sensation like bugs crawling on his skin (sometimes it was a shock). He stated that he scratched the scar often and that it was painful and irritating.

Analysis

Regarding DC 7802, the Veteran's scars have not been shown to total 144 sq. inc. (929 cm) and have not been shown to have been any underlying soft tissue damage. Therefore, a compensable rating is denied.

Regarding DC 7804, throughout the course of this appeal, the Veteran has contended that his scar was painful and itchy. However, his scars have never been found to be unstable. In other words, they have not had frequent loss of covering of the skin over the scars. Additionally, under DC 7804, a 20 percent rating would require three or four scars. At most, the evidence shows that the Veteran has two painful scars, which would qualify for a 10 percent rating. Therefore, as the Veteran does not meet the criteria for a 20 percent rating under DC 7804, a higher rating for the Veteran's scar is denied.

Service Connection

Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active military service. 38 U.S.C. §
itchy. However, his scars have never been found to be unstable. In other words, they have not had frequent loss of covering of the skin over the scars. Additionally, under DC 7804, a 20 percent rating would require three or four scars. At most, the evidence shows that the Veteran has two painful scars, which would qualify for a 10 percent rating. Therefore, as the Veteran does not meet the criteria for a 20 percent rating under DC 7804, a higher rating for the Veteran's scar is denied.

Service Connection

Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Service connection requires competent evidence showing: (1) the existence of a present disability; (2) in-service relationship between the present disability and the disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service (nexus). Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

Service connection may also be established on a secondary basis for a disability which is proximately due to, or aggravated by, a service-connected disability. 38 C.F.R. § 3.310(a).

The Veteran has contended that his reported urinary and bowel incontinence are due to his service-connected low back condition. The Veteran is not contending that these conditions began in or were caused directly caused by his active service, and the evidence also does not suggest that.

A VA opinion was obtained in May 2024, and the VA examiner opined that the Veteran's incontinence was not related to his service-connected back condition. He stated that the MRI showed metastatic adenocarcinoma from prostate cancer which caused compression of the spinal cord, leading to cauda equina syndrome, and that the Veteran's condition improved since removal of the cancer. He stated that before 2022, the Veteran had some urinary frequency, but denied incontinence prior to the onset of cauda equina syndrome.

Another opinion was obtained in September 2024, and the VA examiner opined that the Veteran's bowel/bladder issues were unrelated to his back condition, but rather secondary to metastatic prostate cancer with cord compression.

Another VA opinion was obtained in December 2024, and the VA examiner stated that the Veteran did not have consistent complaints of bowel impairments, and that he had hemorrhoids which were not related to his service-connected radiculopathy or back condition.

Another VA opinion was obtained in March 2025, and the VA examiner opined it was less likely than not that the Veteran's bladder/bowel incontinence was related to his service-connected low back or radicular conditions. He stated that the Veteran's medical records showed metastatic adenocarcinoma from prostate cancer causing compression on his spinal cord (cauda equina syndrome), which improved since his surgery. He stated that the abnormal signal in the L4 mentioned in the Veteran's records, was the tumor. The VA examiner noted that bladder impairment was rarely caused by chronic back conditions in the absence of severe and emergent cauda equina syndrome, and that prostate cancer itself caused urinary symptoms. He stated that advanced prostate cancer, which is what the Veteran was diagnosed with, caused compression of the surrounding structure. The VA examiner acknowledged the Veteran's statements that his bowel/bladder issues began before 2022, but ultimately noted that since the Veteran's cancer was advanced, his prostate cancer long preceded his 2022 diagnosis. He stated that prostate cancer was typically a slow growing cancer which took years/decades to metastasize to other locations, and that it was at least at likely as not that it was present prior to 2017 with onset of urinary frequency.

The Veteran's medical records show he denied urinary incontinence in 2018, and reported loss of bladder/bowel control in May 2022. He also reported progressive weakness in his lower legs, and lower back pain for the last 1-2 months. It was discovered that the Veteran had a tumor on his L4 which was diagnosed as metastatic prostate cancer. The Veteran underwent tumor removal surgery, and his physician noted improvement of back pain and bladder function post decompression from the tumor. In July 2022, the Veteran reported incomplete bladder emptying and bowel incontinence for 2-3 weeks with back pain.

At an August 2023 Board hearing, the Veteran testified that he had spinal surgery in 2022 after he noticed a bulge in his spine. He stated that the doctors removed the bone that covered his spine, and that he had bowel/urinary incontinence.

At
legs, and lower back pain for the last 1-2 months. It was discovered that the Veteran had a tumor on his L4 which was diagnosed as metastatic prostate cancer. The Veteran underwent tumor removal surgery, and his physician noted improvement of back pain and bladder function post decompression from the tumor. In July 2022, the Veteran reported incomplete bladder emptying and bowel incontinence for 2-3 weeks with back pain.

At the August 2025 Board hearing, the Veteran reported he wet himself and complained of bowel and bladder incontinence since before he was diagnosed with prostate cancer. He stated he began complaining of bowel/bladder incontinence since before he was diagnosed with prostate cancer after noticing a suspicious bulge in 2015. The Veteran stated that he believed his back caused his cauda equina.

Here, the Board finds that the evidence shows that it is more likely than not that the Veteran's urinary/bowel incontinence was caused by his metastatic prostate cancer, as opposed to his service-connected low back and/or radicular conditions.

The Veteran denied experiencing bladder/bowel incontinence prior to May 2022; however, the record shows he reported experiencing urinary frequency at various times. In May 2022, he told his physician that he lost control of his bowels and bladder and was referred to the hospital. It was then they discovered a tumor on his spine which was subsequently removed. The Veteran was then diagnosed with metastatic prostate cancer, which caused the tumor.

The various VA examiners who have opined on this issue have come to the same conclusion: that the Veteran's low back/radiculopathy was not the primary cause of any incontinence, but that it was the tumor on his spine that compressed the nerves, resulting in incontinency issues. The March 2025 VA examiner went further, stating that prostate cancer is slow growing and causes urinary frequency, and that it was likely growing well before the Veteran was diagnosed with advanced metastatic cancer.

The Board finds this opinion, in conjunction with the others, to be most probative, given the fact that the Veteran was never found to have any other neurologic abnormalities, including urinary/bowel incontinence, on any VA examination. Additionally, the Veteran is not service connected for prostate cancer, and there is not a claim for prostate cancer currently before the Board. Therefore, the Board cannot grant service connection for urinary/bowel incontinence secondary to prostate cancer.

As such, service connection for urinary/bowel incontinence is denied.

MATTHEW W. BLACKWELDER

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Elizabeth A. Gadson, 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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