PERIPHERAL NERVE CONDITIONS

S. SORATHIA · 2026 · Case ID: A26039174

MIXED

Summary

The veteran, who served in the U.S. Army from September 1989 to September 1993, appeals the denial of service connection for numbness and tingling in the bilateral ring and little fingers, claimed as secondary to her service-connected lumbosacral spine disability. The veteran also appeals the denial of increased ratings for her service-connected radiculopathy of the right lower extremity (femoral nerve) and her lumbosacral spine disability, but seeks a grant for an increased rating for radiculopathy of the left lower extremity (sciatic nerve). The Board reviewed evidence including service treatment records, VA examinations from 1990, 1997, 2019, 2020, and private medical records and opinions submitted by the veteran. The Board found the veteran's service-connected lumbosacral spine disability did not cause or contribute to the numbness and tingling in her fingers, citing a VA clinician's opinion that cervical radiculopathy, not lumbar issues, was responsible. For the left lower extremity radiculopathy, the Board found the evidence supported a 20 percent rating throughout the appeal period, citing consistent lay testimony and objective findings of moderate paresthesias and pain. For the right lower extremity radiculopathy and the lumbosacral spine disability, the Board found the evidence did not support ratings higher than the currently assigned 20 percent and 40 percent, respectively, noting the veteran's symptoms and limitations were consistent with those ratings and that the evidence weighed against a higher evaluation. Service connection for the finger numbness was denied, while the 20 percent rating for left lower extremity radiculopathy was granted.

Rationale

No current disability from claimed finger numbness; Lumbosacral spine disability did not cause or contribute to finger numbness; VA clinician opined cervical radiculopathy responsible for finger symptoms

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

210527-163172

Full Decision Text

Citation Nr: A26039174
Decision Date: 04/27/26 Archive Date: 04/27/26

DOCKET NO. 210527-163172
DATE: April 27, 2026

ORDER

Entitlement to service connection for a disability manifested by numbness and tingling in the bilateral ring and little fingers as secondary to service-connected lumbosacral strain with intervertebral disc syndrome (IVDS) with disc protrusions, degenerative disc disease (DDD), neural foraminal stenosis, and disc subluxations, is denied.

Entitlement to a 20 percent rating effective November 2, 2020, for radiculopathy of the left lower extremity (sciatic nerve) is granted.

Entitlement to a disability rating greater than 20 percent for radiculopathy of the right lower extremity (femoral nerve) is denied.

Entitlement to a disability rating greater than 40 percent for lumbosacral strain with IVDS with disc protrusions, DDD, neural foraminal stenosis, and disc subluxations, is denied.

FINDINGS OF FACT

1. The Veteran consistently limited her appeal for service connection for disability manifested by numbness and tingling in the bilateral ring and little fingers to consideration of whether this disability is secondary to her service-connected lumbosacral strain with IVDS with disc protrusions, DDD, neural foraminal stenosis, and disc subluxations ("lumbosacral spine disability").

2. The Veteran's service-connected lumbosacral spine disability did not cause or contribute to her claimed disability manifested by numbness and tingling in the bilateral ring and little fingers.

3. The symptomatology attributable to the Veteran's service-connected radiculopathy of the left lower extremity (sciatic nerve) more nearly approximates the criteria for a 20 percent rating throughout the appeal period and is manifested by, at worst, moderate paresthesias and/or dysesthesias of the left lower extremity, several visits to the emergency room (ER) with complaints of low back pain and lordosis and sciatica on physical examination, and the use of prescription and over-the-counter medication for treatment.

4. The service-connected radiculopathy of the right lower extremity (femoral nerve) is manifested by, at worst, complaints of pain radiating down the right lower extremity, paresthesias of the right lower extremity, and moderate incomplete paralysis of the right anterior crural (femoral) nerve.

5. The Veteran's service-connected lumbosacral spine disability is manifested by, at worst, complaints of daily low back pain, constant daily moderate to severe flare-ups of pain, moderate tenderness to palpation, pain on weight-bearing, at rest, and on passive range of motion testing, guarding and muscle spasm causing abnormal gait or spinal contour, interference with sitting and standing disturbance of locomotion, IVDS with episodes of bed rest having a total duration of 2 weeks but less than 4 weeks during the past 12 months, constant use of a walker, and forward flexion to 30 degrees.

CONCLUSIONS OF LAW

1. The criteria for service connection for a disability manifested by numbness and tingling in the bilateral ring and little fingers as secondary to service-connected lumbosacral strain with intervertebral disc syndrome with disc protrusions, degenerative disc disease, neural foraminal stenosis, and disc subluxations, have not been met. 38 U.S.C. §§ 1110, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.303, 3.304, 3.310.

2. The criteria for a 20 percent rating effective November 2, 2020, for radiculopathy of the left lower extremity (sciatic nerve) have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.7, 4.124a, Diagnostic Code (DC) 8520.

3. The criteria for a disability rating greater than 20 percent for radiculopathy of the right lower extremity (femoral nerve) have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.124a, DC 8526.

4. The criteria for a disability rating greater than 40 percent for lumbosacral strain with IVDS with disc
.R. §§ 3.102, 4.1, 4.2, 4.7, 4.124a, Diagnostic Code (DC) 8520.

4. The criteria for a disability rating greater than 40 percent for lumbosacral strain with IVDS with disc protrusions, DDD, neural foraminal stenosis, and disc subluxations, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.40, 4.45, 4.59, 4.71a, DC 5243.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran had active U.S. Army service from September 1989 to September 1993.

On November 19, 2020, the Veteran submitted a VA Form 20-0996, Decision Review Request: Higher-Level Review (HLR), and requested review of a November 12, 2020, decision. With the exception of the increased rating claim for radiculopathy of the left lower extremity (sciatic nerve), in March 2021, the Agency of Original Jurisdiction (AOJ) issued an HLR rating decision which considered the evidence of record at the time of the prior November 2020 decision. The AOJ adjudicated the increased rating claim for radiculopathy of the left lower extremity (sciatic nerve) in an April 2021 HLR rating decision which considered the evidence of record at the time of the prior November 2020 decision. In the May 27, 2021, VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran identified the March and April 2021 HLR rating decisions as the rating decisions on appeal and elected the Hearing docket. A Board hearing was held on July 3, 2025, before the undersigned Veterans Law Judge. Therefore, the Board only may consider the evidence of record at the time of the November 2020 AOJ decision which was subsequently subject to HLR as well as any evidence submitted by the Veteran or representative at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). If evidence was submitted either (1) during the period after the AOJ issued the decision which was subsequently subject to HLR and prior to the Board hearing, or (2) more than 90 days following the hearing, then the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801.

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, then she 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, then 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.

The Board notes that the Veteran consistently limited her appeal for service connection for disability manifested by numbness and tingling in the bilateral ring and little fingers to consideration of whether this disability is secondary to her service-connected lumbosacral strain with IVDS with disc protrusions, DDD, neural foraminal stenosis, and disc subluxations ("lumbosacral spine disability"). She listed this issue as separate claims of service connection for numbness and tingling in the ring and little fingers of each hand, each as secondary to her service-connected lumbosacral spine disability, in statements on her September 2020 VA Form 21-526EZ, "Application For Disability Compensation And Related Benefits." The AOJ adjudicated these claims as secondary service connection claims in the currently appealed AMA rating decision issued in November 2020 which was subject to HLR in the currently appealed March 2021 AMA HLR rating decision. The Veteran also listed claims of service connection for numbness and tingling in the ring and little fingers of each hand, each as secondary to her service-connected l
ral spine disability"). She listed this issue as separate claims of service connection for numbness and tingling in the ring and little fingers of each hand, each as secondary to her service-connected lumbosacral spine disability, in statements on her September 2020 VA Form 21-526EZ, "Application For Disability Compensation And Related Benefits." The AOJ adjudicated these claims as secondary service connection claims in the currently appealed AMA rating decision issued in November 2020 which was subject to HLR in the currently appealed March 2021 AMA HLR rating decision. The Veteran also listed claims of service connection for numbness and tingling in the ring and little fingers of each hand, each as secondary to her service-connected lumbosacral spine disability, in statements on her May 2021 VA Form 10182, "Decision Review Request: Board Appeal (Notice Of Disagreement)." She and her representative subsequently testified about this secondary service connection claim on the record at her July 2025 Board hearing. Thus, the Board finds that consideration of this claim is limited to whether the Veteran's service-connected lumbosacral spine disability caused or contributed to her disability manifested by numbness and tingling in the bilateral ring and little fingers. See 38 C.F.R. § 3.310.

The Court recently held that the Board must take due consideration that the beneficial effects of medication are discounted unless such effects are otherwise contemplated in a particular DC. See Ingram v. Collins, 38 Vet. App. 130 (2025). The Veteran's service-connected radiculopathy of the left lower extremity (sciatic nerve), radiculopathy of the right lower extremity (femoral nerve), and lumbosacral spine disability are evaluated under DCs 8520, 8526, and 5243, respectively, which do not contemplate the effects of medication. The VA examiners who saw the Veteran during the appeal period provided range of motion findings for the lumbosacral spine and noted and considered her lay statements describing functional limitations when her pain and functional impairment is at its worst (e.g., during flare ups, on repetitive motion, due to lack of endurance, lack of coordination, etc). The Veteran reported to the October 2019 VA back (thoracolumbar spine) examiner that she took methocarbamol 750 mg as needed and tramadol 50 mg as needed to treat her service-connected lumbosacral spine disability. She reported to the November 2020 VA peripheral nerves conditions DBQ examiner and VA back (thoracolumbar spine) conditions DBQ examiner that she took over-the-counter pain medications and prescription pain medications including gabapentin and Zanaflex to treat her service-connected radiculopathy of the bilateral lower extremities and her service-connected lumbosacral spine disability. Both the October 2019 and November 2020 VA examiners found that the Veteran's lumbosacral spine range of motion was reduced which discounted any potential ameliorating effects of medication. Thus, after resolving any reasonable doubt in the Veteran's favor, the Board finds that record evidence is adequate to adjudicate the currently appealed increased rating claims for service-connected radiculopathy of the left lower extremity (sciatic nerve), service-connected radiculopathy of the right lower extremity (femoral nerve), and service-connected lumbosacral spine disability.

Having reviewed the record evidence, the Board finds that the issues on appeal should be characterized as stated above. Neither the Veteran nor her representative has raised any other issues nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 369 370 (2017) (confirming that Board not required to address issues unless specifically raised by claimant or reasonably raised by record evidence). The Veteran was employed prior to the rating decision on appeal.

1. Entitlement to service connection for a disability manifested by numbness and tingling in the bilateral ring and little fingers as secondary to a service-connected lumbosacral spine disability

The Board is not persuaded that the evidence supports granting service connection for a disability manifested by numbness and tingling in the bilateral ring and little fingers as secondary to service-connected lumbosacral spine disability. As noted above, the Veteran consistently limited this appeal to consideration of whether her service-connected lumbosacral spine disability caused or contributed to her disability manifested by numbness and tingling in the bilateral ring and little fingers. See 38 C.F.R. § 3.310. She and her service representative essentially contend that her service-connected lumbosacral spine disability caused her to experience numbness and tingling in the ring and little fingers of each of her hands. However, the record evidence shows instead that the Veteran does not experience any current disability due to her claimed disability manifested by numbness and tingling in the bilateral ring and little fingers. It also shows that her service-connected lumbosacral spine disability did not cause or contribute to her claimed disability manifested by numbness and tingling in the bilateral ring and little fingers.

The available service treatment records show that, at her enlistment physical examination in August 1989, prior to her entry on to active service in September 1989, clinical evaluation was within normal limits. The Veteran also denied any relevant pre-service medical history.

She was seen in the ER at a military medical facility on January 16, 1990, complaining that she jammed her right pinky (or little) finger. Objective examination of the right little finger showed moderate tenderness in the dorsal interphalangeal (DIP) joint and proximal interphalangeal (PIP) joint and no ecchymosis. X-rays showed no fracture. The assessment was right small finger sprain.

On outpatient treatment on January 23, 1990, the Veteran complained of pain in the right small (dominant) finger for the previous 10 days. This finger had been taped for the past 10 days and she had not used that digit during that time. Objective examination of the right little finger showed pain/point tenderness on the volar surface and radial side of the small finger PIP joint without instability, effusion over the radial side of the PIP joint, and a full active range of motion. X-rays showed no fracture. The Veteran reported pain when this digit was stressed. The assessment was radial collateral ligament on the right small finger which "requires additional protection." The Veteran received a dorsal protective splint to wear for 14 days.

On January 30, 1990, the Veteran reported no change in her pain level despite wearing the protective splint secondary to radial collateral ligament of the right small finger. Objective examination of the right small finger showed continued pain/point tenderness on the dorsal aspect of the PIP joint proximally to the metacarpophalangeal (MCP) joint and continued pain/point tenderness and effusion on the radial aspect of the PIP joint. The assessment was that the Veteran presented with continued pain/point tenderness at the right small finger "requiring continued protection" with the treatment goal not met.

On February 6, 1990, the Veteran complained, "Last week I hit my small finger against the bed post and now my finger feels worse. It's difficult for me to hold pots." She had worn a protective splint secondary to radial collateral ligament of the right small finger for 2 weeks. Objective examination of the right small finger showed pain upon palpation of the dorsal right small finger PIP joint and proximal phalanx and increased pain on the radial aspect, edema, and a limited range of motion. The assessment was that the Veteran "presents to clinic with an increase in pain which may limit but not impede her performance in training. [Treatment] goal has not yet been met."

The evidence of record shows that she does not experience any current disability due to her claimed disability manifested by numbness and tingling in the bilateral ring and little fingers. It also shows instead that her service-connected lumbosacral spine disability did not cause or contribute to her claimed disability manifested by numbness and tingling in the bilateral ring and little fingers. It is undisputed that service connection currently is in effect for a lumbosacral spine disability.

On VA hand, thumb, and fingers examination in May 1997, the Veteran's complaints included occasional pain or mild discomfort "with tightening up related to activities, such as chopping food" following "a jamming type injury" to her right small finger during active service "which was treated with resting and a splint." The VA examiner stated that the Veteran's in-service right small finger injury "subsequently healed up and she has stable use of her hand." Objective examination of the right hand showed no anatomical or functional defects, a normal range of motion "of all fingers and thumb," normal grasp and fine motor dexterity, "an area of mild discomfort over the dorsal aspect of the [MCP] joint in the small finger," and symmetric strength. X-rays were not indicated because the Veteran was 33 weeks pregnant. The diagnosis was status-post impaction/jamming injury of the right fifth finger resulting in chronic tendonitis of the small finger extensor hood. The VA examiner stated, "There may[]be a component of mild post-traumatic arthritis involved with the fifth [MCP] joint which could be delineated on x-rays....Her discomfort appears to be fairly minimal in nature at this time."

On VA hand and finger conditions Disability Benefits Questionnaire (DBQ) in May 2017, the Veteran's complaints included numbness and tingling in the ring and pinky finger of the right hand. The VA examiner reviewed the Veteran's electronic claims file, including service treatment records and post-service VA treatment records. The Veteran reported an in-service jamming injury to the right small finger. She described functional impairment or functional loss as difficulty with grip. Range of motion testing of the right hand was normal. Physical examination of the hands showed pain on use, mild tenderness to palpation in the fourth and fifth fingers of the right hand, 4/5 strength in the right hand, and 5/5 strength in the left hand. X-rays were normal. There was objective evidence of pain on passive range of motion testing and on non-weight bearing in the right hand. There was no objective evidence of pain on passive range of motion testing and on non-weight bearing in the left hand. The diagnosis was right fourth/fifth digit strain.

On VA hand and finger conditions DBQ in November 2017, the Veteran's complaints included right pinky (or little) finger numbness from her finger "down to her hand," right little finger numbness, and "stillness." She took tramadol and oxycodone "with good relief" of her pain. She was right-hand dominant. The VA examiner reviewed the Veteran's electronic claims file, including service treatment records and post-service VA treatment records. The Veteran described her functional loss or impairment as "limitations with gripping." Range of motion testing for both hands was normal. Physical examination of the hands showed right hand pain on finger flexion not resulting in/causing functional loss, pain with use of the right hand, no pain in the left hand, 4/5 muscle strength in the right hand, and 5/5 muscle strength in the left hand. There was no evidence of pain on passive range of motion testing or when used in non-weight bearing for both hands. The Veteran regularly wore a brace for right little finger tendonitis. The VA examiner stated, "[The] Veteran has difficulty gripping. The Veteran can perform general activities without significant restrictions." The diagnosis was right little finger tendonitis.

In a November 2020 opinion, a VA clinician opined that it is less likely than not that the Veteran's claimed disability manifested by numbness and tingling in the bilateral ring and little fingers was proximately due to or the result of her service-connected lumbosacral spine disability. The rationale for this opinion was based on a review of the claims file. The rationale also was "Cervical radiculopathy is responsible for any numbness and tingling in the upper extremities and would not be related to Veterans IVDS or degenerative disc disease in her lumbar spine." The rationale further was that there were no results in the Veteran's claims file showing that she had "degenerative disc disease of the cervical spine[]which would be a cause for cervical radiculopathy."

It is undisputed that service connection currently is in effect for a lumbosacral spine disability. Nevertheless, the record evidence does not suggest that the Veteran experiences
service-connected lumbosacral spine disability. The rationale for this opinion was based on a review of the claims file. The rationale also was "Cervical radiculopathy is responsible for any numbness and tingling in the upper extremities and would not be related to Veterans IVDS or degenerative disc disease in her lumbar spine." The rationale further was that there were no results in the Veteran's claims file showing that she had "degenerative disc disease of the cervical spine[]which would be a cause for cervical radiculopathy."

It is undisputed that service connection currently is in effect for a lumbosacral spine disability. Nevertheless, the record evidence does not suggest that the Veteran experiences current disability due to her claimed disability manifested by numbness and tingling in the bilateral ring and little fingers which is related to her service-connected lumbosacral spine disability. The November 2020 VA clinician specifically opined that it is less likely than not that the claimed disability manifested by numbness and tingling in the bilateral ring and little fingers was proximately due to or the result of a service-connected lumbosacral spine disability. This VA clinician opined instead that cervical radiculopathy is responsible for the Veteran's complaints of numbness and tingling in the bilateral ring and little fingers and she was not diagnosed as having degenerative disc disease which caused cervical radiculopathy. This opinion was fully supported. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (finding that a medical opinion "must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions"). The Veteran and her attorney otherwise have not identified or submitted any evidence demonstrating her entitlement to service connection for a disability manifested by numbness and tingling in the bilateral ring and little fingers as due to a service-connected lumbosacral spine disability. The evidence persuasively weighs against the claim. Therefore, the benefit of the doubt rule does not apply. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc). In summary, the Board finds that service connection for a disability manifested by numbness and tingling in the bilateral ring and little fingers as due to a service-connected lumbosacral spine disability is not warranted.

2. Entitlement to a disability rating greater than 20 percent prior to November 2, 2020, and 10 percent thereafter, for radiculopathy of the left lower extremity (sciatic nerve)

The Board next is persuaded that the evidence supports assigning a 20 percent rating effective November 2, 2020, for the service-connected radiculopathy of the left lower extremity (sciatic nerve). Having reviewed the record evidence, the Board finds that a single 20 percent rating should be assigned for the service-connected radiculopathy of the left lower extremity (sciatic nerve) throughout the appeal period under DC 8520. See 38 C.F.R. § 4.124a, DC 8520. Consistent with the lay assertions from the Veteran and her representative, the record evidence as a whole shows that the symptomatology attributable to this disability more nearly approximates the criteria for a 20 percent rating throughout the appeal period. It specifically shows that this disability is manifested by, at worst, moderate paresthesias and/or dysesthesias of the left lower extremity, several visits to the ER with complaints of low back pain and lordosis and sciatica on physical examination, and the use of prescription and over-the-counter medication for treatment throughout the appeal period. The Veteran also testified credibly at her July 2025 Board hearing that the symptomatology attributable to her service-connected radiculopathy of the left lower extremity (sciatic nerve) had not changed during the appeal period. Evidence submitted following this hearing during an applicable AMA evidentiary window (although dated prior to the hearing) further demonstrates that the symptomatology attributable to this service-connected disability did not improve during the appeal period and supports the assignment of a single 20 percent rating throughout the appeal period under DC 8520. Id.

The record evidence shows that, on VA back (thoracolumbar spine) conditions DBQ in October 2019, the Veteran's complaints included weakness of the left lower extremity. She treated her complaints with methocarbamol 750 mg as needed, tramadol 50 mg as needed, and by taking a warm shower as needed. Physical examination showed moderate constant pain of the left lower extremity. The VA examiner stated that the Veteran's radiculopathy of the left lower extremity was mild in severity. This examiner also stated
service-connected disability did not improve during the appeal period and supports the assignment of a single 20 percent rating throughout the appeal period under DC 8520. Id.

The record evidence shows that, on VA back (thoracolumbar spine) conditions DBQ in October 2019, the Veteran's complaints included weakness of the left lower extremity. She treated her complaints with methocarbamol 750 mg as needed, tramadol 50 mg as needed, and by taking a warm shower as needed. Physical examination showed moderate constant pain of the left lower extremity. The VA examiner stated that the Veteran's radiculopathy of the left lower extremity was mild in severity. This examiner also stated that the Veteran was status-post transient ischemic attack (TIA) in December 2018 "and has some residual weakness" of the right lower extremity.

On VA back (thoracolumbar spine) conditions DBQ in March 2020, the Veteran's complaints included a "burning sensation and lack of feeling in my legs." She treated her complaints with tramadol. The VA examiner reviewed the Veteran's electronic claims file, including service treatment records and post-service VA treatment records. Physical examination showed moderate constant pain, moderate intermittent pain, moderate paresthesias and/or dysesthesias, and moderate numbness of the left lower extremity involving the sciatic nerve. The VA examiner stated that the Veteran's radiculopathy of the left lower extremity was moderate in severity. The Veteran constantly used a back brace for her radiculopathy of the left lower extremity. The diagnoses included radiculopathy of the left lower extremity involving the L4-S1 nerve roots.

The Veteran reported to the ER at a private hospital in July, August, and September 2020 complaining of low back pain on each ER visit. A review of these ER treatment records shows that, in August 2020, the Veteran's complaints included sharp and burning low back pain which radiated into both thighs, sciatica pain of the bilateral lower extremities which radiated up in to her spine, and bilateral leg pain. Her low back pain "worsened with movement and walking." She rated her low back pain as 9/10 on a pain scale (with 10/10 being the worst imaginable pain). Physical examination showed lordosis of the back and bilateral sciatica. The impressions included lumbago with sciatica on the left side.

On VA peripheral nerves conditions DBQ on November 2, 2020, the Veteran's complaints included low back pain radiating down the right lower extremity and paresthesias of the right lower extremity. The VA examiner reviewed the Veteran's electronic claims file, including service treatment records and post-service VA treatment records. The Veteran stated that she treated her symptoms with physical therapy, facet blockers, over-the-counter pain medications, and prescription pain medications including gabapentin and Zanaflex. Physical examination showed mild intermittent pain and moderate paresthesias and/or dysesthesias of the left lower extremity.

On VA back (thoracolumbar spine) conditions DBQ on November 2, 2020, no relevant complaints were noted. The VA examiner reviewed the Veteran's electronic claims file, including service treatment records and post-service VA treatment records. Physical examination showed mild constant pain and moderate paresthesias and/or dysesthesias of the left lower extremity.

The Veteran testified at her July 2025 Board hearing that the symptomatology attributable to her service-connected radiculopathy of the left lower extremity (sciatic nerve) had not improved. She described her worsening symptoms as "razor sharp" shooting pain from her knees to her feet which occurred once or twice a week lasting for several minutes at a time. See Board hearing transcript dated July 3, 2025, at pp. 3-4.

In a "Physician's Statement For Disability Retirement," dated in March 2023 and received electronically by VA in July 2025 during an applicable AMA evidentiary window, a private clinician stated that the Veteran had experienced chronic pain in the legs "for many years." This clinician also stated that the Veteran's condition was "not likely" to improve.

Consistent with the lay assertions from the Veteran and her representative, the record evidence as a whole shows that the symptomatology attributable to this disability more nearly approximates the criteria for a 20 percent rating throughout the appeal period (i.e., before and after November 2, 2020) under DC 8520. See 38 C.F.R. § 4.124a, DC 8520. It shows that this disability is manifested by, at worst, moderate paresthesias and/or dysesthesias of the left lower extremity, several visits to the ER with complaints of low back pain and lordosis and sciatica on physical examination, and the use of prescription and over-the-counter medication for treatment throughout the appeal period. As noted above, the Veteran testified credibly at her July 2025 Board hearing that the symptomatology attributable to her service-connected radiculopathy of the left lower extremity (sciatic nerve) had not changed. See Board hearing transcript dated July 3, 2025, at pp. 3-4. The Veteran's hearing testimony is consistent with the objective findings obtained on VA examinations conducted throughout the appeal period showing that there was no improvement in the symptomatology attributable to this service-connected disability. And evidence submitted by the Veteran in support of his claim following her Board hearing during an applicable AMA evidentiary window (although dated in March 2023 prior to the July 2025 hearing) indicates that her condition is "not likely" to improve.

Taken together, the record evidence as a whole supports assigning a single 20 percent rating for her service-connected radiculopathy of the left lower extremity (sciatic nerve) throughout the appeal period under DC 8520. Id. There is no indication, however, that the Veteran experiences at least moderately severe or severe incomplete paralysis or complete paralysis of the sciatic nerve of the right lower extremity such that a disability rating greater than 20 percent is warranted for her service-connected radiculopathy of the left lower extremity (sciatic nerve) at any time during the appeal period under this DC. Id. She and her attorney otherwise have not identified or submitted any evidence demonstrating her entitlement to a disability rating greater than 20 percent for her service-connected radiculopathy of the left lower extremity (sciatic nerve). In summary, and after resolving any reasonable doubt in the Veteran's favor, the Board finds that the criteria for a 20 percent rating effective November 2, 2020, for radiculopathy of the left lower extremity (sciatic nerve) have been met.

3. Entitlement to a disability rating greater than 20 percent for radiculopathy of the right lower extremity (femoral nerve)

The Board next is not persuaded that the evidence supports assigning a disability rating greater than 20 percent for radiculopathy of the right lower extremity (femoral nerve). The Veteran and her representative essentially contend that this disability is more disabling than currently evaluated. The Board disagrees. Contrary to the lay assertions from the Veteran and her representative, the record evidence shows instead that this disability is manifested by, at worst, complaints of pain radiating down the right lower extremity, paresthesias of the right lower extremity, and moderate incomplete paralysis of the right anterior crural (femoral) nerve. These findings noted on a VA examination conducted during the appeal period support the 20 percent rating currently assigned for the service-connected radiculopathy of the right lower extremity (femoral nerve) throughout the appeal period under DC 8526. See 38 C.F.R. § 4.124a, DC 8526.

On VA peripheral nerves conditions DBQ in November 2020, the Veteran's complaints included low back pain radiating down the right lower extremity and paresthesias of the right lower extremity. The VA examiner reviewed the Veteran's electronic claims file, including service treatment records and post-service VA treatment records. The Veteran stated that she treated her complaints with physical therapy, facet blockers, over-the-counter pain medications, and prescription pain medications including gabapentin and Zanaflex. Physical examination showed moderate incomplete paralysis of the right anterior crural (femoral) nerve. The Veteran constantly used a walker "for [a] combination of any of her diagnosed conditions to include intervertebral disc syndrome, degenerative disc disease, [and] right lower extremity radiculopathy to include [the] femoral and sciatic nerves."
lower extremity and paresthesias of the right lower extremity. The VA examiner reviewed the Veteran's electronic claims file, including service treatment records and post-service VA treatment records. The Veteran stated that she treated her complaints with physical therapy, facet blockers, over-the-counter pain medications, and prescription pain medications including gabapentin and Zanaflex. Physical examination showed moderate incomplete paralysis of the right anterior crural (femoral) nerve. The Veteran constantly used a walker "for [a] combination of any of her diagnosed conditions to include intervertebral disc syndrome, degenerative disc disease, [and] right lower extremity radiculopathy to include [the] femoral and sciatic nerves." The VA examiner stated that the Veteran's peripheral nerves condition impacted her ability to perform any occupational task. She was unable to ambulate without a walker, do any "prolonged standing or walking of any distance," and to lift anything weighing "greater than 5 to 10 pounds." The diagnosis was lumbar radiculopathy affecting the right lower extremity femoral nerve.

The Veteran testified at her July 2025 Board hearing that she experienced "electric shock" symptoms and was unable to walk due to her service-connected radiculopathy of the right lower extremity (femoral nerve). She also testified that she took multiple over-the-counter and prescription medications to treat this disability. See Board hearing transcript dated July 3, 2025, at pp. 10-11. She testified further that she needed assistance walking, her right leg felt like it was giving way, and she experienced right thigh numbness due to this disability. Id., at pp. 13-14.

Contrary to the lay assertions from the Veteran and her representative, the record evidence shows that the service-connected radiculopathy of the right lower extremity (femoral nerve) is manifested by, at worst, complaints of pain radiating down the right lower extremity, paresthesias of the right lower extremity, and moderate incomplete paralysis of the right anterior crural (femoral) nerve (as seen on VA examination in November 2020). These findings support the 20 percent rating currently assigned for this disability throughout the appeal period under DC 8526. See 38 C.F.R. § 4.124a, DC 8526. VA examination in November 2020 documented the Veteran's complaints of low back pain radiating down the right lower extremity and paresthesias of the right lower extremity. The Veteran stated that she treated her complaints with physical therapy, facet blockers, over-the-counter pain medications, and prescription pain medications including gabapentin and Zanaflex. Physical examination showed moderate incomplete paralysis of the right anterior crural (femoral) nerve. There is no indication that the Veteran experiences severe incomplete paralysis or complete paralysis of the anterior crural (femoral) nerve of the right lower extremity such that a disability rating greater than 20 percent for service-connected radiculopathy of the right lower extremity (femoral nerve) is warranted at any time during the appeal period under DC 8526. Id. Although the November 2020 VA examiner stated that the Veteran was unable to walk without a walker, this examiner also stated that the Veteran used a walker due to the combined effects of her service-connected musculoskeletal disabilities and not solely because of her service-connected radiculopathy of the right lower extremity (femoral nerve). And, as noted in the Introduction, the VA clinicians appropriately discounted the Veteran's use of medication consistent with Ingram. The Veteran and her representative otherwise have not identified or submitted any evidence demonstrating her entitlement to a disability rating greater than 20 percent for her service-connected radiculopathy of the right lower extremity (femoral nerve). The evidence persuasively weighs against the claim. Therefore, the benefit of the doubt rule does not apply. See Lynch, 21 F.4th at 776. In summary, the Board finds that the criteria for a disability rating greater than 20 percent for radiculopathy of the right lower extremity (femoral nerve) have not been met.

4. Entitlement to a disability rating greater than 40 percent for a lumbosacral strain with intervertebral disc syndrome with disc protrusions, degenerative disc disease,
evidence demonstrating her entitlement to a disability rating greater than 20 percent for her service-connected radiculopathy of the right lower extremity (femoral nerve). The evidence persuasively weighs against the claim. Therefore, the benefit of the doubt rule does not apply. See Lynch, 21 F.4th at 776. In summary, the Board finds that the criteria for a disability rating greater than 20 percent for radiculopathy of the right lower extremity (femoral nerve) have not been met.

4. Entitlement to a disability rating greater than 40 percent for a lumbosacral strain with intervertebral disc syndrome with disc protrusions, degenerative disc disease, neural foraminal stenosis, and disc subluxations

The Board next is not persuaded that the evidence supports assigning a disability rating greater than 40 percent for lumbosacral strain with intervertebral disc syndrome with disc protrusions, degenerative disc disease, neural foraminal stenosis, and disc subluxations. The Veteran and her representative essentially contend that this disability has worsened. The Board disagrees. Contrary to the lay assertions from the Veteran and her representative, the record evidence shows that this disability is manifested by, at worst, complaints of daily low back pain, constant daily moderate to severe flare-ups of pain, moderate tenderness to palpation, pain on weight-bearing, at rest, and on passive range of motion testing, guarding and muscle spasm causing abnormal gait or spinal contour, interference with sitting and standing disturbance of locomotion, IVDS with episodes of bed rest having a total duration of 2 weeks but less than 4 weeks during the past 12 months, constant use of a walker, and forward flexion to 30 degrees throughout the appeal period. These findings support the 40 percent rating currently assigned for the service-connected lumbosacral strain with intervertebral disc syndrome with disc protrusions, degenerative disc disease, neural foraminal stenosis, and disc subluxations ("lumbosacral spine disability") throughout the appeal period under DC 5243. See 38 C.F.R. § 4.71a, DC 5243.

On VA back (thoracolumbar spine) conditions DBQ in October 2019, the Veteran's complaints included progressively worsening low back pain, an altered gait, tightening on the right side of her back, pain radiating up the back "and creates weakness." She took methocarbamol 750 mg as needed, tramadol 50 mg as needed, and took hot showers as needed to treat her back problems. The VA examiner reviewed the Veteran's electronic claims file, including service treatment records and post-service VA treatment records. The Veteran described flare-ups of low back pain as, "When I am sitting or standing for long periods of time my back tightens up and feels like a knot is in there." She described her functional loss or impairment as, "I toss and turn at night and with standing because of the back pain." Range of motion testing of the lumbosacral spine showed forward flexion to 60 degrees, extension to 20 degrees, lateral flexion to 30 degrees in each direction, and lateral rotation to 30 degrees in each direction. All ranges of motion exhibited pain. The VA examiner stated, "Veteran is grimacing in pain and gait is unsteady." There was no additional limitation of motion on repetitive testing. The DeLuca factors of pain, fatigue, and weakness were present on repeated use over time and on flare-ups of low back pain due to "increased pain, fatigue, weakness, and unsteady gait with prolonged weightbearing."

Physical examination of the lumbosacral spine in October 2019 showed pain with weight bearing and causing functional loss, moderate tenderness to palpation, guarding and muscle spasm resulting in abnormal gait or spinal contour, interference with sitting and standing, 5/5 muscle strength throughout except for 4/5 muscle strength on right hip flexion and right knee extension, normal deep tendon reflexes except for 1+ reflexes in the right knee, normal sensation throughout, positive straight leg raising bilaterally, and no ankylosis, no other neurologic abnormalities, and IVDS with episodes of bed rest having a total duration of 2 weeks but less than 4 weeks during the past 12 months. The VA examiner stated, "[The] Veteran reports being seen in the [ER] due to back pain [in] October 2018 and states that she was out of work for 3 weeks afterwards." The Veteran regularly used a cane. X-rays showed arthritis. The VA examiner also stated that the Veteran's back condition impacted
right hip flexion and right knee extension, normal deep tendon reflexes except for 1+ reflexes in the right knee, normal sensation throughout, positive straight leg raising bilaterally, and no ankylosis, no other neurologic abnormalities, and IVDS with episodes of bed rest having a total duration of 2 weeks but less than 4 weeks during the past 12 months. The VA examiner stated, "[The] Veteran reports being seen in the [ER] due to back pain [in] October 2018 and states that she was out of work for 3 weeks afterwards." The Veteran regularly used a cane. X-rays showed arthritis. The VA examiner also stated that the Veteran's back condition impacted her ability to work because she reported that she "[m]issed 2-3 weeks from work due to back pain [in] October 2018." The diagnoses were lumbosacral strain and IVDS.

An undated VA magnetic resonance imaging (MRI) scan of the Veteran's lumbosacral spine and date-stamped as received electronically by the AOJ in March 2020 showed multiple small disc protrusions, chronic degenerative disc disease, and chronic subluxation.

On VA back (thoracolumbar spine) conditions DBQ in March 2020, the Veteran's complaints included daily spine pain through the entire spine. She treated her complaints with tramadol. The VA examiner reviewed the Veteran's electronic claims file, including service treatment records and post-service VA treatment records. The Veteran reported constant moderate to severe flare-ups which occurred daily. She described her functional loss or impairment as "pain." Range of motion testing of the lumbosacral spine showed forward flexion to 30 degrees, extension to 5 degrees, lateral flexion to 10 degrees in each direction, and lateral rotation to 10 degrees in each direction. There was no additional limitation of motion on repetitive testing and during flare-ups of low back pain. The DeLuca factors of pain and lack of endurance were present on repeated use over time. Physical examination of the lumbosacral spine showed pain at rest/non-movement, pain with weight bearing, moderate tenderness to palpation in the spinous processes, 5/5 muscle strength, normal deep tendon reflexes, decreased sensation in the bilateral knees, lower leg/ankles, and toes/feet, positive straight leg raising bilaterally, and no ankylosis, other neurologic abnormalities, or IVDS. The Veteran constantly used a back brace. A November 2019 MRI scan provided to the VA examiner by the Veteran showed "disc protrusions, degenerative disc disease, neural foraminal stenosis and disc subluxations." There was objective evidence of pain on passive range of motion testing. There was no evidence of pain on non-weight bearing. The diagnoses included lumbosacral strain with disc protrusions, DDD, neural foraminal stenosis, and disc subluxations.

On VA back (thoracolumbar spine) conditions DBQ in November 2020, the Veteran's complaints included low back pain. She treated her low back pain with physical therapy, facet blockers, over-the-counter pain medications, and prescription pain medications, including gabapentin and Zanaflex. The VA examiner reviewed the Veteran's electronic claims file, including service treatment records and post-service VA treatment records. The Veteran experienced flare-ups of low back pain which she described as, "My really bad days I can even get out of bed due to the excruciating pain in my lower back. The spasms also quite severe and I require assistance getting out of bed and doing routine things such as going to the restroom." She described her functional loss or impairment as, "I am unable to do routine chores around the house such as bending over to pick something up off the ground ,which is impossible now. I can't lift any kind of heavy objects greater than five or 10 pounds. And I oftentimes need assistance just doing routine things such as going to the restroom, or showering."

Range of motion testing of the lumbosacral spine in November 2020 showed forward flexion to 30 degrees, extension to 10 degrees, right lateral flexion to 10 degrees, left lateral flexion to 15 degrees, right lateral rotation to 30 degrees, and left lateral rotation to 20 degrees. The Veteran had pain on flexion, extension, and on lateral flexion in both directions. There was no additional limitation of motion on repetitive testing. The DeLuca factors of pain, fatigue, weakness, and lack of endurance were present on repetitive use over time and on flareups of low back pain. Physical examination of the lumbosacral spine showed moderate tenderness to palpation in the bilateral paraspinal musculature, pain with weight bearing, less movement than normal, disturbance of locomotion, interference with sitting and standing, 4/5 muscle strength throughout on the right side, 5/5 muscle strength throughout on the left side, normal reflexes, normal sensation throughout except for decreased sensation in the right thigh/knee, decreased sensation in the right lower leg/ankle, and absent sensation in the right foot/toes, negative straight leg raising bilaterally, no ankylosis or other neurological abnormality, and IVDS but without any episodes of acute signs and symptoms which required bed rest prescribed by a physician and treatment by a physician in the past 12 months. The Veteran constantly used a walker. X-rays showed arthritis. The VA examiner stated that the Veteran's lumbosacral spine disability impacted her ability to work because she was unable to walk without a walker, pick up objects weighing more than 10 pounds, go up and down stairs, and to tolerate prolonged standing or walking. There was no objective evidence of pain on non-weight bearing. Passive range of motion testing could not be performed because it was not appropriate medically. The diagnoses were lumbosacral strain, degenerative arthritis of the spine, and IVDS.

Contrary to the lay assertions from the Veteran and her representative, the record evidence shows that her service-connected lumbosacral spine disability is manifested by, at worst, complaints of daily low back pain, constant daily moderate to severe flare-ups of pain, moderate tenderness to palpation, pain on weight-bearing, at rest, and on passive range of motion testing, guarding and muscle spasm causing abnormal gait or spinal contour, interference with sitting and standing disturbance of locomotion, IVDS with episodes of bed rest having a total duration of 2 weeks but less than 4 weeks during the past 12 months, constant use of a walker, and forward flexion to 30 degrees. These findings support the 40 percent rating currently assigned for the service-connected lumbosacral spine disability throughout the appeal period under DC 5243. Id. VA examinations conducted during the appeal period document the Veteran's consistent reports of ongoing daily low back pain and constant daily moderate to severe flare-ups of pain. Physical examinations of the lumbosacral spine conducted during the appeal period showed moderate tenderness to palpation pain on weight-bearing, at rest, and on passive range of motion testing, guarding and muscle spasm causing abnormal gait or spinal contour, interference with sitting and standing disturbance of locomotion, and IVDS with episodes of bed rest having a total duration of 2 weeks but less than 4 weeks during the past 12 months. The Veteran constantly used a walker. And forward flexion of the lumbosacral spine was limited to, at worst, 30 degrees. There is no indication that the Veteran experienced unfavorable ankylosis of the entire thoracolumbar spine or the entire spine at any time during the appeal period as is required for a disability rating greater than 40 percent for her service-connected lumbosacral spine disability under DC 5243. Id. There was no ankylosis found on the VA examinations conducted during the appeal period. The Veteran also is in receipt of separate compensable ratings for the radiculopathy she experiences in the sciatic and femoral nerves of the right lower extremity and for radiculopathy of in the sciatic nerve of the left lower extremity. As noted above, she is not entitled to increased ratings for either her service-connected radiculopathy of the left lower extremity (sciatic nerve) or for her service-connected radiculopathy of the right lower extremity (femoral nerve). And, as noted in the Introduction, the VA clinicians appropriately discounted the Veteran's use of medication consistent with Ingram.

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She and her representative otherwise have not identified or submitted any evidence demonstrating her entitlement to a disability rating greater than
compensable ratings for the radiculopathy she experiences in the sciatic and femoral nerves of the right lower extremity and for radiculopathy of in the sciatic nerve of the left lower extremity. As noted above, she is not entitled to increased ratings for either her service-connected radiculopathy of the left lower extremity (sciatic nerve) or for her service-connected radiculopathy of the right lower extremity (femoral nerve). And, as noted in the Introduction, the VA clinicians appropriately discounted the Veteran's use of medication consistent with Ingram.

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She and her representative otherwise have not identified or submitted any evidence demonstrating her entitlement to a disability rating greater than 40 percent for her service-connected lumbosacral spine disability. The evidence persuasively weighs against the claim. Therefore, the benefit of the doubt rule does not apply. See Lynch, 21 F.4th at 776. In summary, the Board finds that the criteria for a disability rating greater than 40 percent for lumbosacral strain with intervertebral disc syndrome with disc protrusions, degenerative disc disease, neural foraminal stenosis, and disc subluxations have not been met.

S. Sorathia

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Michael T. Osborne, 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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