DEGENERATIVE ARTHRITIS OF THE SPINE (SPONDYLOSIS)

JOHN R. DOOLITTLE, II · 2026 · Case ID: A26040469

MIXED

Summary

The Veteran served on active duty from January 1967 to January 1973. The Veteran appeals decisions denying higher ratings for his back and knee conditions, and an earlier effective date for a right lower extremity sciatic nerve radiculopathy claim. The Board reviewed the evidence of record at the time of the April and July 2025 rating decisions, as the Veteran withdrew his request for a Board hearing. For the back disability, the Board denied ratings in excess of 20 percent prior to March 31, 2025, and in excess of 40 percent from that date, finding the evidence did not support higher impairment levels. Similarly, for the right and left knee conditions, including strains, osteoarthritis, and instability, the Board denied ratings in excess of 10 percent, concluding the evidence did not meet the criteria for higher evaluations. The Board also denied an effective date prior to March 31, 2025, for the right lower extremity sciatic nerve radiculopathy claim. However, an earlier effective date of October 25, 2022, was granted for the left lower extremity sciatic nerve radiculopathy, with a 10 percent rating warranted prior to March 31, 2025. From March 31, 2025, a rating in excess of 20 percent for the left lower extremity sciatic nerve radiculopathy was denied. Finally, the Board granted entitlement to a total disability rating based on individual unemployability (TDIU), finding the schedular criteria were met.

Rationale

Prior to March 31, 2025, criteria for higher than 20% rating not met.; From March 31, 2025, criteria for higher than 40% rating not met.; No evidence of ankylosis, specific motion limitations, or prolonged incapacitating episodes.

Special Benefit

TDIU

Diagnostic Code

5243

Docket No.

250813-564906

Full Decision Text

Citation Nr: A26040469
Decision Date: 04/30/26 Archive Date: 04/30/26

DOCKET NO. 250813-564906
DATE: April 30, 2026

ORDER

Prior to March 31, 2025, a rating in excess of 20 percent for the Veteran's degenerative disc disease of the L4-L5 lumbar spine, spondylosis deformans of the lumbar spine and intervertebral disc syndrome (IVDS) with degenerative arthritis (a back disability) is denied.

From March 31, 2025, a rating in excess of 40 percent for the Veteran's back disability is denied.

Entitlement to a rating in excess of 10 percent for right knee strain with osteoarthritis is denied.

Entitlement to a rating in excess of 10 percent for left knee strain with osteoarthritis is denied.

Entitlement to a rating in excess of 10 percent for right knee instability is denied.

Entitlement to a rating in excess of 10 percent for left knee instability is denied.

An effective date prior to March 31, 2025, for the award of service connection for right lower extremity sciatic nerve radiculopathy is denied.

An earlier effective date of October 25, 2022, for the award of service connection for left lower extremity sciatic nerve radiculopathy is granted, subject to regulations governing payment of monetary awards.

Entitlement to a rating in excess of 20 percent for right lower extremity sciatic nerve radiculopathy is denied.

A 10 percent rating for left lower extremity sciatic nerve radiculopathy is warranted prior to March 31, 2025, from the earlier effective date of October 25, 2022, subject to the regulations governing payment of monetary awards.

From March 31, 2025, a rating in excess of 20 percent for left lower extremity sciatic nerve radiculopathy is denied.

Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is granted, subject to the regulations governing payment of monetary awards.

FINDINGS OF FACT

1. Prior to March 31, 2025, at no time was the Veteran's back disability shown to have been manifested by forward flexion of the thoracolumbar spine limited to 30 degrees or less or by ankylosis of the thoracolumbar spine; the Veteran did not experience incapacitating episodes having a total duration of at least four weeks but less than six weeks during the past 12 months.

2. From March 31, 2025, the Veteran's back disability has not been shown to have been manifested by unfavorable ankylosis of the entire thoracolumbar spine or by incapacitating episodes having a total duration of at least 6 weeks in a 12-month period.

3. Throughout the appeal period, the Veteran's right knee disability has been manifested by no worse than extension limited to 10 degrees or arthritis with X-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups with painful motion. There was no competent evidence of ankylosis, dislocation or removal of the semilunar cartilage, impairment of the tibia or fibula, or genu recurvatum.

4. Throughout the appeal period, the Veteran's left knee disability has been manifested by no worse than extension limited to 10 degrees or arthritis with x-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups with painful motion. There was no competent evidence of ankylosis, dislocation or removal of the semilunar cartilage, impairment of the tibia or fibula, or genu recurvatum.

5. Throughout the rating period on appeal, the evidence is persuasively against finding that the Veteran's right knee instability has manifested in a patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for one of the following: a brace, cane, or walker; or, either (a) sprain, incomplete ligament tear, or repaired complete ligament tear causing persistent instability, and a medical provider prescribing a brace and/or assistive device (e.g., cane(s), crutch(es), walker) for ambulation; or (b) unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribing either an assistive device (e.g., cane(s), crutch(es), walker) or bracing for ambulation.

6. Throughout the rating period on appeal, the evidence is persuasively against finding that the Veteran's left knee instability has manifested in a patello
by a medical provider for one of the following: a brace, cane, or walker; or, either (a) sprain, incomplete ligament tear, or repaired complete ligament tear causing persistent instability, and a medical provider prescribing a brace and/or assistive device (e.g., cane(s), crutch(es), walker) for ambulation; or (b) unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribing either an assistive device (e.g., cane(s), crutch(es), walker) or bracing for ambulation.

6. Throughout the rating period on appeal, the evidence is persuasively against finding that the Veteran's left knee instability has manifested in a patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for one of the following: a brace, cane, or walker; or, either (a) sprain, incomplete ligament tear, or repaired complete ligament tear causing persistent instability, and a medical provider prescribing a brace and/or assistive device (e.g., cane(s), crutch(es), walker) for ambulation; or (b) unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribing either an assistive device (e.g., cane(s), crutch(es), walker) or bracing for ambulation.

7. The Veteran's claim seeking service connection for a lumbar spine disability (on which the subsequent grant of service connection for right lower extremity sciatic nerve radiculopathy was based) was received by VA in June 2014; right lower extremity sciatic nerve radiculopathy was first diagnosed on March 31, 2025, VA back examination.

8. The Veteran's left lower extremity sciatic nerve radiculopathy is a manifestation of his service-connected back disability, and it is factually ascertainable that the Veteran had symptoms of left lower extremity sciatic radiculopathy on October 25, 2022, the date of a VA treatment record which showed an assessment of low back pain with mild left sciatica symptoms.

9. Throughout the period on appeal, the Veteran's right lower extremity sciatic nerve radiculopathy is shown to have been manifested by no more than moderate incomplete paralysis of the sciatic nerve on the right lower extremity; moderately severe incomplete paralysis of the sciatic nerve was not shown.

10. Prior to March 31, 2025, from the earlier effective date of October 25, 2022, the Veteran's left lower extremity sciatic nerve radiculopathy was shown to have been manifested by no more than mild incomplete paralysis of the sciatic nerve on the left lower extremity; moderate incomplete paralysis of the sciatic nerve was not shown.

11. From March 31, 2025, the Veteran's left lower extremity sciatic nerve radiculopathy is shown to have been manifested by no more than moderate incomplete paralysis of the sciatic nerve on the right lower extremity; moderately severe incomplete paralysis of the sciatic nerve was not shown.

12. The Veteran's service-connected disabilities of IVDS with degenerative arthritis (rated 20 percent from June 13, 2014, and 40 percent from March 31, 2025), right lower extremity sciatic nerve radiculopathy (rated 20 percent), left lower extremity sciatic nerve radiculopathy (rated 20 percent), tinnitus (rated 10 percent), right knee strain (rated 10 percent), left knee strain (rated 10 percent), right knee instability (rated 10 percent), left knee instability (rated 10 percent), bilateral hearing loss (rated 0 percent), and hypertension (rated 0 percent), are reasonably shown to be of such nature and severity as to preclude his participation in any regular substantially gainful employment consistent with his education and occupational experience.

CONCLUSIONS OF LAW

1. Prior to March 31, 2025, a rating in excess of 20 percent for the Veteran's back disability is not warranted. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.10, 4.21, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5243.

2. From March 31, 2025, a rating in excess of 40 percent for the Veteran's back disability is not warranted. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.10, 4
38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.10, 4.21, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5243.

2. From March 31, 2025, a rating in excess of 40 percent for the Veteran's back disability is not warranted. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.10, 4.21, 4.40, 4.45, 4.59, 4.71a, Code 5243.

3. Entitlement to a rating in excess of 10 percent for a right knee disability is not warranted. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Codes 5003, 5261.

4. Entitlement to a rating in excess of 10 percent for a left knee disability is not warranted. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Codes 5003, 5261.

5. Entitlement to a rating in excess of 10 percent for right knee instability is not warranted. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Code 5257.

6. Entitlement to a rating in excess of 10 percent for left knee instability is not warranted. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Code 5257.

7. An effective date prior to March 31, 2025, for the award of service connection for right lower extremity sciatic nerve radiculopathy is not warranted. 38 U.S.C. § 5110; 38 C.F.R. § 3.400.

8. The criteria for entitlement to an effective date of October 25, 2022, but no earlier, for the award of service connection for left lower extremity sciatic radiculopathy have been met. 38 U.S.C. § 5110; 38 C.F.R. § 3.400.

9. Throughout the period on appeal, a rating in excess of 20 percent for right lower extremity sciatic nerve radiculopathy is not warranted. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321(b)(1), 4.1, 4.21, 4.124a, Code 8520.

10. Prior to March 31, 2025, from the earlier effective date of October 25, 2022, a 10 percent, but no higher, rating is warranted for left lower extremity sciatic nerve radiculopathy. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321(b)(1), 4.1, 4.21, 4.124a, Code 8520.

11. From March 31, 2025, a rating in excess of 20 percent for left lower extremity sciatic nerve radiculopathy is not warranted. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321(b)(1), 4.1, 4.21, 4.124a, Code 8520.

12. The schedular criteria for a TDIU rating are met, and a TDIU rating is warranted. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.340, 3.341, 4.3, 4.16.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The appellant is a Veteran who served on active duty from January 1967 to January 1973. This matter is before the Board of Veterans' Appeals (Board)
.R. §§ 3.321(b)(1), 4.1, 4.21, 4.124a, Code 8520.

12. The schedular criteria for a TDIU rating are met, and a TDIU rating is warranted. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.340, 3.341, 4.3, 4.16.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The appellant is a Veteran who served on active duty from January 1967 to January 1973. This matter is before the Board of Veterans' Appeals (Board) on appeal from April 2025 and July 2025 rating decisions. In August 2025, the Veteran timely appealed the April 2025 and July 2025 rating decisions to the Board and requested the Board hearing option. However, in November 2025, the Veteran withdrew his request for a Board hearing. Therefore, the Board's review is limited to evidence on record at the time of the April 2025 and July 2025 rating decisions (for their respective issues) and evidence submitted at or within 90 days of the November 2025 withdrawal of the Board hearing request. See 38 C.F.R. §§ 20.302(b).

1. Prior to March 31, 2025, a rating in excess of 20 percent for a back disability is denied.

2. From March 31, 2025, a rating in excess of 40 percent for the Veteran's back disability is denied.

The Veteran asserts that his back disability warrants a rating in excess of 20 percent prior to March 31, 2025, and in excess of 40 percent from that date.

Disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. 38 U.S.C. § 1155; C.F.R., Part 4. Separate diagnostic codes identify the various disabilities. Disabilities must be reviewed in relation to their history. 38 C.F.R. § 4.1. Reasonable doubt regarding the degree of disability is to be resolved in favor of the claimant. 38 C.F.R. § 4.3. Functional impairment is to be assessed on the basis of lack of usefulness, and the effects of the disability upon the person's ordinary activity. 38 C.F.R. § 4.10. See Schafrath v. Derwinski, 1 Vet. App. 589 (1991).

When the appeal is from the initial rating assigned with a grant of service connection, the severity of the disability during the entire period from the grant of service connection to the present is to be considered. "Staged" ratings may be assigned for distinct periods when different levels of impairment are shown. Fenderson v. West, 12 Vet. App. 119 (1999).

When evaluating a service-connected disability based on limitation of motion, the Board must take into consideration functional loss due to pain under 38 C.F.R. § 4.40 and functional loss due to weakness, fatigability, incoordination or pain on movement of a joint under 38 C.F.R. § 4.45. See DeLuca v. Brown, 8 Vet. App. 202 (1995). In DeLuca, the CAVC held that a diagnostic code based on limitation of motion does not subsume 38 C.F.R. §§ 4.40 and 4.45 and that the rule against pyramiding set forth in 38 C.F.R. § 4.14 does not forbid consideration of a higher rating based on a greater limitation of motion due to pain on use, including use during flare-ups. Id. A finding of functional loss due to pain must be supported by adequate pathology and evidenced by the visible behavior of the Veteran. 38 C.F.R. § 4.40; Johnston v. Brown, 10 Vet. App. 80, 85 (1997).

Nonetheless, a rating higher than the minimum compensable rating is not assignable under any diagnostic code relating to range of motion where pain does not cause a compensable functional loss. Rather, the "pain must affect some aspect of 'the normal working movements of the body' such as 'excursion, strength, speed, coordination, and endurance,'" as defined in 38 C.F.R. § 4.40, before a higher rating may be assigned. See Mitchell v. Shinseki, 25 Vet. App. 32, 37 (2011).

The
C.F.R. § 4.40; Johnston v. Brown, 10 Vet. App. 80, 85 (1997).

The Veteran's back disability is rated under 38 C.F.R. § 4.71a, Code 5243 under the General Formula. Under the General Rating Formula, a 10 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or vertebral body fracture with loss of 50 percent or more of the height. A 20 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 40 percent rating is assigned where forward flexion of the thoracolumbar spine is to 30 degrees or less, or if there is favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine, while a 100 percent rating is warranted for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, General Rating Formula. Additionally, any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, are to be evaluated separately under the appropriate diagnostic codes. Id. at Note (1).

As noted above, the Veteran's back disability is currently rated under Diagnostic Code 5243. While portions of the rating schedule addressing the musculoskeletal system were revised effective February 7, 2021, the rating criteria for this diagnostic code was not changed.

Normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, left and right lateral flexion are zero to 30 degrees, and left and right lateral rotation are zero to 30 degrees. The normal combined range of motion of the thoracolumbar spine is 240 degrees. The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. 38 C.F.R. § 4.71a, Code 5242, Note (2).

Unfavorable ankylosis is defined, in pertinent part, as "a condition in which the entire thoracolumbar spine is fixed in flexion or extension." Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. Id.

In Chavis v. McDonough, the Court held that the requirement of ankylosis can be met with evidence of the functional equivalent of ankylosis (i.e., functional immobility of the joint) during a flare-up and/or with repeated use due to the DeLuca factors. 34 Vet. App. 1 (2021).

The intent of the Rating Schedule is to recognize painful motion with joint or periarticular pathology as productive of disability. It is the intention to recognize actually painful, unstable, or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. 38 C.F.R. § 4.59.

Additionally, under the IVDS Formula, (because the Veteran has a diagnosis of IVDS) a 10 percent rating is awarded for incapacitating episodes having a total duration of at least one week but less than two weeks during the past 12 months. 38 C.F.R. § 4.71a. A 20 percent rating is awarded for incapacitating episodes having a total duration of at least two weeks but less than four weeks during the past 12 months. Id. A 40 percent rating is awarded for incapacitating episodes having a total duration of at least four weeks but less than six weeks during the past 12 months. Id. A 60 percent rating is assigned for incapacitating episodes having a total duration of at least six weeks during the past 12 months. Id. Under Note 1 of the IVDS Formula, for purposes of evaluations under DC 5243, an incapacitating episode is a period of acute signs and symptoms due to IVDS that requires bed rest prescribed by a physician and treatment by a physician.

A July 2014 VA treatment record notes that the Veteran reported intermittent low back pain and that he used non-steroidal anti-inflammatory drugs (NSAIDS) as needed. On evaluation, his lumbar range of motion (ROM) was normal.

A December 2018 VA treatment record notes that the Veteran reported right knee arthritis and back pain. The evaluation was negative for radicular pain and loss of motor or sensory function.

In a July 2019 private opinion, the provider noted that he reviewed the Veteran's claims file and indicated that the Veteran's back pain limited his activities. It was noted that the Veteran related that he had constant back pain and had difficulty getting out of bed and doing daily household chores. The provider indicated that the record showed that he walked with an antalgic gait and that X-rays showed osteoarthritis with spondylitic changes as L3-L4. The provider noted that a previous examination indicated that the Veteran had marked limitation of extension of his low back with decreased flexion. He also had positive straight leg raising testing bilaterally and reported continued pain with bending, lifting, and stooping. The provider opined that due to his significant knee and low back disabilities, the Veteran could not seek and maintain gainful employment.

A December 2019 VA treatment record notes that the Veteran had muscle spasms which were palpable to the left SI joint and lower lumbar spine.

A February 2021 VA treatment record notes that the Veteran reported experiencing back pain for several years. He related that his back pain is an 8/10 in severity on average and that his back pain is worse in the morning and improves once he starts moving around. The Veteran reported that the was leaving for the Philippines in two weeks and requested a home exercise plan. He related that he liked to garden, fish, and ride his bike. The provider noted that the Veteran ambulated from the waiting area to the examination room with guarded gait. ROM testing showed lumbar flexion to 65 degrees and extension to 10 degrees. Muscular testing was 5/5 in the lower extremities. No lower extremity atrophy was observed. Sensation was currently intact to light touch in the bilateral lower extremities. The Veteran's reflexes were 2+ bilaterally in knee jerk and 1+ in ankle jerk. He was provided a TENS unit.

A June 2022 VA treatment record notes that the Veteran's gait and station were normal. He stood without difficulty, his Romberg was steady, and his posture was normal. The Veteran reported chronic back pain that he managed with Robaxin and Naprosyn as needed and with a heating pad.

An October 2022 VA treatment record notes that the assessment was low back pain with mild left sciatica symptoms.

A May 2023 VA treatment record notes that the assessment was low back pain with mild left sciatica symptoms.

A March 2024 VA treatment record notes that the Veteran had low back pain with mild left sciatica symptoms.

In a February 2025 private opinion, the provider opined that the Veteran's thoracolumbar spine condition caused him to be unable to perform gainful work activities involving bending, twisting, lifting, prolonged standing, and prolonged walking.

On March 2025 VA back examination, degenerative arthritis, degenerative disc disease, intervertebral disc syndrome, and s
pad.

An October 2022 VA treatment record notes that the assessment was low back pain with mild left sciatica symptoms.

A May 2023 VA treatment record notes that the assessment was low back pain with mild left sciatica symptoms.

A March 2024 VA treatment record notes that the Veteran had low back pain with mild left sciatica symptoms.

On March 2025 VA back examination, degenerative arthritis, degenerative disc disease, intervertebral disc syndrome, and spondylolisthesis were diagnosed. The Veteran reported back spasms, guarding, pain, and weakness, and that he took over the counter medications and prescription medications for pain. He related that he also utilized a heating pad and ice therapy as needed. The Veteran reported back flare-ups which he described as an inability to walk during a flare-up, except maybe to the bathroom. He also related that during some flare-ups, he has to crawl to the bathroom, cannot stand for more than a few minutes, or cannot stand at all. The Veteran reported that he can only sleep for about 1 hour and either has to sit up and stretch or roll over into a new position. He related that his sleep was severely degraded and impacted his day-to-day interactions with loved ones, acquaintances, and strangers because it made him more irritable. The Veteran reported that he experiences flare-ups monthly, they last almost a week per episode, and the severity is a 10/10. Functional impairment was described as an inability to walk over 300 yards without rest, stand for more than 5 minutes without having to rest, lift any weight over 5 pounds, and walk without pain. The Veteran also reported that navigating steps was very difficult.

ROM testing showed forward flexion to 20 degrees, extension to 5 degrees, right and left lateral flexion to 10 degrees, and right and left lateral rotation to 10 degrees. All ranges of motion exhibited pain. Passive ROM testing not performed because it was not feasible to do this in a safe and reasonable manner as the Veteran could be further injured. There was pain on weight-bearing, non-weight-bearing, active motion, and on rest/non-movement that caused functional loss. There was no crepitus or pain on palpation. The Veteran was able to perform repetitive use testing with no additional loss of function or range of motion. He was not being examined immediately after repeated use over time or during a flare-up, and it was noted that procured evidence suggested that pain, fatigability, weakness, lack of endurance, and incoordination significantly limited functional ability with repeated use over time and/or during a flare-up. The estimated ROM after repeated use over time and during a flare-up was forward flexion to 15 degrees, extension to 0 degrees, right and left lateral flexion to 5 degrees and right and left lateral rotation to 5 degrees. The Veteran had localized tenderness not resulting in abnormal gait or abnormal spinal contour and had muscle spasm resulting in abnormal gait or abnormal spinal contour. He also had guarding resulting in abnormal gait or abnormal spinal contour. Muscle strength testing was 4/5 in hip and knee extension bilaterally and 5/5 in ankle plantar flexion, ankle dorsiflexion, and great toe extension bilaterally. Muscle atrophy was not shown. Reflex examination was normal. Sensory examination was normal in the bilateral upper thigh and decreased in the bilateral thigh/knee, lower leg/ankle, and foot/toes. Straight leg raising test was positive. Radicular pain was reported. The Veteran reported severe intermittent pain in the right and left lower extremities and moderate paresthesia and numbness in the right and left lower extremities. There was involvement of the sciatic nerve bilaterally. Ankylosis of the spine was not shown. The Veteran had IVDS, and it was noted that he had not had any episodes of acute signs and symptoms due to IVDS that required bed rest prescribed by a physician and treatment by a physician in the past 12 months. He did not report the use of assistive devices. X-rays showed minimal anterolisthesis of L4 and L5, moderate lumbar spondylosis, and thoracic spondylosis.

A March 2025 VA treatment record notes that the Veteran had low back pain with mild left sciatica symptoms.

On June 2025 VA back examination, degenerative arthritis, degenerative disc disease, IV
Ankylosis of the spine was not shown. The Veteran had IVDS, and it was noted that he had not had any episodes of acute signs and symptoms due to IVDS that required bed rest prescribed by a physician and treatment by a physician in the past 12 months. He did not report the use of assistive devices. X-rays showed minimal anterolisthesis of L4 and L5, moderate lumbar spondylosis, and thoracic spondylosis.

A March 2025 VA treatment record notes that the Veteran had low back pain with mild left sciatica symptoms.

On June 2025 VA back examination, degenerative arthritis, degenerative disc disease, IVDS, spondylolisthesis, and right and left lower extremity lumbar radiculopathy were diagnosed. The Veteran reported that he continues to have back pain that radiates down both legs. He related that he undergoes acupuncture, takes prescribed medication, and used a heating pad to alleviate his symptoms. The Veteran reported that he experienced difficulty with walking and standing for prolonged periods, as well as with bending, lifting, and squatting. His functional limitations included, difficulty transitioning from sitting to standing, prolonged walking, bending, and an inability to pick up objects from the floor. The Veteran reported that he also had difficulty completing household chores and yardwork. He related that his back flare-ups occurred daily, were moderate, and lasted for three hours.

ROM testing showed forward flexion to 15 degrees, extension to 10 degrees, right and left lateral flexion to 15 degrees, and right and left lateral rotation to 15 degrees. There was pain on all ROMs except left lateral rotation. Passive ROM testing was not performed because it could cause the Veteran severe pain or the risk of further injury. There was pain on active ROM that did not cause functional loss. Crepitus was not observed. There was evidence of tenderness or pain on palpation to the sacral coccyx. The Veteran could perform repetitive use testing with no additional loss of function or ROM. He was not being examined immediately after repeated use over time. The examiner noted that pain significantly limited functional ability with repeated use over time. The estimated ROM was forward flexion to 10 degrees, extension to 10 degrees, right and left lateral flexion to 10 degrees, and right and left lateral rotation to 10 degrees. The Veteran was not being examined during a flare-up. The examiner noted that pain and lack of endurance significantly limited functional ability during a flare-up. The estimated ROM was forward flexion to 5 degrees, extension to 5 degrees, right and left lateral flexion to 5 degrees, and right and left lateral rotation to 5 degrees. The Veteran had localized tenderness not resulting in abnormal gait or abnormal spinal contour. There was no muscle spasm or guarding. Additional factors contributing to disability included disturbance of locomotion and interference with standing. The Veteran related that he had difficulty with walking and standing for long periods of time.

Muscle strength testing was 4/5 in both lower extremities except for great toe extension, which was 5/5 bilaterally. Muscle atrophy was not observed. Sensory examination was normal. The straight leg raising test was positive. Radicular signs or symptoms were present. The Veteran reported severe intermittent pain in the right and left lower extremities, moderate paresthesia in the right and left lower extremities, and mild numbness in the right and left lower extremities. There was involvement of the sciatic nerve bilaterally. Ankylosis was not shown. Although the Veteran had IVDS, he had not had any episodes of acute signs and symptoms due to IVDS that required bed rest prescribed by a physician and treatment by a physician in the past 12 months. He did not report the use of assistive devices. Functional impact was described as difficulty with bending, squatting, kneeling, and lifting. He was also unable to walk or stand for prolonged periods without having to rest. These conditions impaired the Veteran's ability to perform tasks that require prolonged standing, walking, sitting, or repetitive movements. The examiner also noted that he had functional limitations which included difficulty with lifting, bending, twisting, and maintaining postural positions for extended periods. It was noted that the Veteran may require frequent position changes and may be unable to perform physically demanding tasks, which can significantly impact requiring manual labor, prolonged activity, or static postures.

In a February 2026 vocational assessment, the provider indicated that she conducted a telephone interview with the Veteran, and he described symptoms of difficulty with prolonged standing, walking, and sitting, having to constantly change positions
He was also unable to walk or stand for prolonged periods without having to rest. These conditions impaired the Veteran's ability to perform tasks that require prolonged standing, walking, sitting, or repetitive movements. The examiner also noted that he had functional limitations which included difficulty with lifting, bending, twisting, and maintaining postural positions for extended periods. It was noted that the Veteran may require frequent position changes and may be unable to perform physically demanding tasks, which can significantly impact requiring manual labor, prolonged activity, or static postures.

In a February 2026 vocational assessment, the provider indicated that she conducted a telephone interview with the Veteran, and he described symptoms of difficulty with prolonged standing, walking, and sitting, having to constantly change positions to achieve comfort, and pain and instability while ambulating, which he asserted had been present since at least June 2014. He reported intense back and knee pain that caused him issues with prolonged standing, walking, and sitting. The Veteran related that he often has to have help from his wife to rise from the bed in the morning due to his elevated levels of pain. He also reported that he was no longer able to do yard work.

Prior to March 31, 2025, the Board finds that a rating in excess of 20 percent is not warranted for the Veteran's back disability. In a July 2019 private opinion, the provider indicated that the Veteran's back pain limited his activities, and it was noted that he had related that he had constant back pain and had difficulty getting out of bed and doing daily household chores. The provider indicated that the record showed that he walked with an antalgic gait and that due to his back and knee disabilities, he could not maintain gainful employment. However, in a February 2021 VA treatment record, although the Veteran related that his back pain was an 8/10 in severity on average and that his back pain was worse in the morning and improved once he starts moving around, on evaluation, spine ROM testing showed lumbar flexion to 65 degrees and extension to 10 degrees. Also, muscular testing was 5/5 in the lower extremities. Additionally, the Veteran related that he liked to garden, fish, and ride his bike. He also reported that he was leaving for the Philippines in two weeks and requested a home exercise plan. A June 2022 VA treatment record notes that the Veteran's gait and station were normal. He stood without difficulty, his Romberg was steady, and his posture was normal. The Veteran reported chronic back pain that he managed with Robaxin and Naprosyn as needed and with a heating pad. Additionally, in a February 2025 private opinion, the provider opined that the Veteran's thoracolumbar spine condition caused him to be unable to perform gainful work activities involving bending, twisting, lifting, prolonged standing, and prolonged walking. Further, regarding IVDS, the record does not show that prior to March 31, 2025, the Veteran had incapacitating episodes having a total duration of at least four weeks but less than six weeks during the past 12 months. The Board notes that although the Veteran has reported throughout the period on appeal that he has had back pain that was sometimes intense, the evidence of record does not show a defined period in which such pain manifested (or approximated) flexion of the thoracolumbar spine to 30 degrees or less, or showed favorable ankylosis of the entire thoracolumbar spine. Additional factors that could provide a basis for an increased rating have also been considered; however, it is not shown that the Veteran has any functional loss beyond that being currently compensated. 38 C.F.R. §§ 4.10, 4.40, 4.45; DeLuca, 8 Vet. App. at 205. As the criteria for the 20 percent rating assigned throughout the period on appeal prior to March 31, 2025, encompass the greatest degree of severity of a back disability shown at any time during that period, the Board finds that a rating in excess of 20 percent for the Veteran's back disability prior to March 31, 2025, is not warranted.

From March 31, 2025, the Veteran's back disability has been assigned a 40 percent rating (as noted above). The evidence of record does not show that at any time during this period, symptoms of the disability met (or approximated) the criteria for the next higher, 50 percent, rating under the General Formula, or the next higher, 60 percent, rating under the formula for rating IVDS. To warrant a 50 percent rating under the General Formula, the evidence would have to show unfavorable ankylosis of the entire thoracolumbar spine, and to warrant a 60 percent rating under the formula for IVDS, the evidence would have to show incapacitating episodes having a total duration of at least 6 weeks during a 12 month period. Such limitations are not shown. On March 2025 VA examination, the Veteran reported back flare-ups which he described as an inability to walk during a flare-up, except maybe to the bathroom. He also related that during some flare-ups, he has to crawl to the bathroom, cannot stand for more than a few minutes, or cannot stand at all. ROM testing showed forward flexion to 20 degrees, extension to 5 degrees, right and left lateral flexion to 10 degrees, and right and left lateral rotation to 10 degrees. All ranges of motion exhibited pain. The estimated ROM after repeated use over time and during a flare-up was forward flexion to 15 degrees, extension to 0 degrees, right and left lateral flexion to 5 degrees and right and left lateral rotation to 5 degrees. The Veteran had localized tenderness not resulting in abnormal gait or abnormal spinal contour and had muscle spasm resulting in abnormal gait or abnormal spinal contour. The Veteran had IVDS, and it was noted that he had not had any episodes of acute signs and symptoms due to IVDS that required bed rest prescribed by a physician and treatment by a physician in the past 12 months. On June 2025 VA back examination, the Veteran reported that he experienced difficulty with walking and standing for prolonged periods, as well as with bending, lifting, and squatting. His functional limitations included, difficulty transitioning from sitting to standing, prolonged walking, bending, and an inability to pick up objects from the floor. The Veteran reported that he also had difficulty completing household chores and yardwork. He related that his back flare-ups occurred daily, were moderate, and lasted for three hours. ROM testing showed forward flexion to 15 degrees, extension to 10 degrees, right and left lateral flexion to 15 degrees, and right and left lateral rotation to 15 degrees. There was pain on all ROMs except left lateral rotation. The examiner noted that pain significantly limited functional ability with repeated use over time. The estimated ROM was forward flexion to 10 degrees, extension to 10 degrees, right and left lateral flexion to 10 degrees, and right and left lateral rotation to 10 degrees. The Veteran was not being examined during a flare-up. The examiner noted that pain and lack of endurance significantly limited functional ability during a flare-up. The estimated ROM was forward flexion to 5 degrees, extension to 5 degrees, right and left lateral flexion to 5 degrees, and right and left lateral rotation to 5 degrees. Although the Veteran had IVDS, he had not had any episodes of acute signs and symptoms due to IVDS that required bed rest prescribed by a physician and treatment by a physician in the past 12 months. Ankylosis was not shown on either examination. The Board notes that although the Veteran has reported throughout the period on appeal that he has had back pain that was sometimes intense, the evidence of record does not show a defined period in which such pain manifested (or approximated) unfavorable ankylosis of the entire thoracolumbar spine or by incapacitating episodes having a total duration of at least 6 weeks in a 12 month period.

Therefore, at no time from March 31, 2025, is it shown that the Veteran had functional loss beyond that compensated by the current ratings assigned. 38 C.F.R. §§ 4.10, 4.40, 4.45; DeLuca, 8 Vet. App. at 205. As the criteria for the 40 percent rating encompass the greatest severity of back disability shown at any time from March 31, 2025, the Board finds that a rating in excess of 40 percent for the disability from March 31, 2025, is not warranted, and the Veteran's claim seeking a
total duration of at least 6 weeks in a 12 month period.

Therefore, at no time from March 31, 2025, is it shown that the Veteran had functional loss beyond that compensated by the current ratings assigned. 38 C.F.R. §§ 4.10, 4.40, 4.45; DeLuca, 8 Vet. App. at 205. As the criteria for the 40 percent rating encompass the greatest severity of back disability shown at any time from March 31, 2025, the Board finds that a rating in excess of 40 percent for the disability from March 31, 2025, is not warranted, and the Veteran's claim seeking a rating in excess of 40 percent for his back disability is denied.

Recently the U.S. Court of Appeals for Veterans Claims (CAVC) issued a precedential decision in Ingram v. Collins, 38 Vet. App. 130 (2025), which indicated that when the Board evaluates musculoskeletal disabilities where the relevant Diagnostic Code does not reference medication use, the Board must discount beneficial medication effects and evaluate the baseline severity of each disability. The Board observes that on March 2025 VA back examination, he took over the counter medications and prescription medications and on June 2025 VA back examination, the Veteran reported that he undergoes acupuncture, takes prescribed medication, and used a heating pad to alleviate his symptoms.

The Board is cognizant of the fact that the Veteran has used over the counter medications and prescription pain medication to treat his back pain but notes, however, that Ingram does not address how the Board is to discount the beneficial effects of medication, particularly when used as treatment for musculoskeletal symptoms and where examiners do not reasonably have the ability to assess range of motion both with and without use of medication. Moreover, in this case, the VA examiners, in rendering range of motion findings, noted and considered the Veteran's lay statements describing functional limitations when his pain and functional impairment is at its worst (e.g., during flare ups, on repetitive motion, due to lack of endurance, and lack of coordination, etc.). On examination, the Veteran did not report how often he used the over the counter medications, the name of his prescription pain medication, or how often he took the pain medication, but in any case, it is clear the examiner already provided an opinion estimating range of motion findings and considered the Veteran's description of when his pain is at its worst. As such, the Board finds the report and the remainder of the evidentiary record adequate to base a decision, resolving all reasonable doubt in the Veteran's favor.

3. Entitlement to a rating in excess of 10 percent for right knee strain is denied.

4. Entitlement to a rating in excess of 10 percent for left knee strain is denied.

5. A rating in excess of 10 percent for right knee instability is denied.

6. A rating in excess of 10 percent for left knee instability is denied.

The Veteran seeks ratings in excess of 10 percent for his right and left knee strain and right and left knee instability.

At the outset, the Board will discuss whether the Veteran's knee claims were continuously pursued.

In a June 2024 decision, the Board denied ratings in excess of 10 percent for right knee strain and left knee strain and granted, without assigning effective dates, 10 percent ratings for right and left knee instability.

A June 2024 rating decision implemented the grants of service connection for right and left knee instability and assigned the effective date of June 13, 2014, for each disability.

In May 2025, the Veteran filed a VA Form 21-8940, Application for Increased Compensation Based on Unemployability, seeking a TDIU rating. The Regional Office (RO) then determined that claims seeking increased ratings for right and left knee disabilities were also on appeal.

A claim of entitlement to a TDIU is essentially a claim for an increased rating. See Hurd v. West, 13 Vet. App. 449 (2000). Generally, the effective date of an increased rating is the date of receipt of claim or date entitlement arose, whichever is later. 38 U.S.C. § 5110; 38 C.F.R. § 3.400(o)(1). Except, if it is factually ascertainable based on all evidence of record that an increase in disability had occurred and a complete claim or intent to file a claim was received within one year from such date. 38 C.F.R. § 3.400(o)(2).

A claimant may continuously pursue a claim or an issue by timely and properly filing for certain administrative review options after any decision by the AOJ, Board, or the
449 (2000). Generally, the effective date of an increased rating is the date of receipt of claim or date entitlement arose, whichever is later. 38 U.S.C. § 5110; 38 C.F.R. § 3.400(o)(1). Except, if it is factually ascertainable based on all evidence of record that an increase in disability had occurred and a complete claim or intent to file a claim was received within one year from such date. 38 C.F.R. § 3.400(o)(2).

A claimant may continuously pursue a claim or an issue by timely and properly filing for certain administrative review options after any decision by the AOJ, Board, or the U.S. Court of Appeals for Veterans Claims. 38 U.S.C. § 5110; 38 C.F.R. § 3.2500.

The Board finds that, although the TDIU claim was filed within one year of the June 2024 Board and rating decisions, the TDIU application would not qualify as being in continuous pursuit of the issues in the decisions. 38 U.S.C. § 5110; 38 C.F.R. § 3.2500.

Under the AMA system, an initial claim for an increased rating (via Form 21-526EZ) is not considered a request for review of a prior decision, but rather a claim for an increased rating based on a change or worsening after the previous decision. See 38 C.F.R. § 3.1(p)(1) (defining a claim for increased rating as an "initial claim" rather than a "supplemental claim").

A claim for TDIU is considered a type of increased-rating claim. See Hurd v. West, 13 Vet. App. 449 (2000) (indicating that a TDIU claim is a claim for increased compensation and, therefore, the same effective date rules for increased compensation claims apply to a TDIU claim).

Here, the Veteran filed a VA Form 21-8940 requesting TDIU on May 5, 2025. This request for TDIU via a VA Form 21-8940 is considered an increased-rating claim. Accordingly, the TDIU claim cannot be considered a request for review of a prior decision; instead, it is a claim for an increased rating based on a change or worsening after the previous decision. See 38 C.F.R. § 3.1(p)(1). As such, although the TDIU claim was filed within one year of a Board or rating decision, the TDIU claim does not qualify as continuous pursuit of prior decisions. A claim for a TDIU is a claim for increased rating that in turn is an initial claim rather than a supplemental claim. Such a claim does not qualify as continuous pursuit of prior decisions. Therefore, the period on appeal for the knee disabilities is one year prior to the May 5, 2025, receipt of the TDIU claim, which is back to May 5, 2024.

The Veteran's service-connected left and right knee disabilities, characterized as,

left knee strain with osteoarthritis and degenerative arthritis, have been assigned

10 percent initial evaluations under 38 C.F.R. § 4.71a, Diagnostic Codes 5003-

5261, pertaining to arthritis and rated on the provisions regarding limitation of

extension of the knee. See 38 C.F.R. § 4.27 (reflecting that hyphenated diagnostic

codes are used when a rating under one diagnostic code requires use of an

additional diagnostic code to identify the basis for the assigned rating; the

additional code is shown after the hyphen).

Diagnostic Code 5003 provides that degenerative arthritis established by X-ray

findings is to be evaluated on the basis of limitation of motion under the

appropriate Code for the specific joint or joints involved. When, however, the limitation of motion of the specific joint or joints involved is noncompensable under the appropriate Code, a rating of 10 percent is for application for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added under Code 5003. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. In the absence of limitation of motion, a 10 percent rating is assignable for X-ray evidence of involvement of arthritis of two or more major joints or two or more minor joint groups. A 20 percent evaluation is assignable for X-ray evidence of involvement of arthritis of two or more major joints or two or more minor joint groups, with occasional incapacitating exacerbations. 38
is noncompensable under the appropriate Code, a rating of 10 percent is for application for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added under Code 5003. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. In the absence of limitation of motion, a 10 percent rating is assignable for X-ray evidence of involvement of arthritis of two or more major joints or two or more minor joint groups. A 20 percent evaluation is assignable for X-ray evidence of involvement of arthritis of two or more major joints or two or more minor joint groups, with occasional incapacitating exacerbations. 38 C.F.R. § 4.71a. For purpose of rating disability from arthritis, the knee is considered a major joint. 38 C.F.R. § 4.45 (f).

Under Code 5260, limitation of knee flexion, a noncompensable (zero percent) rating is warranted where flexion of the knee is limited to 60 degrees. A 10 percent

disability evaluation is warranted when flexion is limited to 45 degrees. A 20

percent disability rating is warranted when flexion is limited to 30 degrees, and a

30 percent rating is warranted when flexion of the leg is limited to 15 degrees. 38 C.F.R. § 4.71a, Code 5260.

Under Code 5261, limitation knee extension, a noncompensable (zero percent) rating is warranted when extension of the knee is limited to 5 degrees. A 10 percent disability rating is warranted when extension of the knee is limited to 10 degrees. A 20 percent disability rating is warranted when extension is limited to 15 degrees, and a 30 percent rating is warranted when extension limited to 20 degrees. A 40 percent disability rating is warranted when extension is limited to 30 degrees, and a 50 percent disability rating is warranted when extension of the leg is limited to 45 degrees. 38 C.F.R. § 4.71a, Code 5261.

For rating purposes, normal range of motion in a knee joint is from 0 degree of

extension to 140 degrees of flexion. 38C.F.R. §4.71, Plate II.

Under Code 5258, dislocation of the semilunar cartilage of the knee with frequent

episodes of "locking," pain and effusion into the joint warrants a 20 percent

disability rating. 38 C.F.R. § 4.71a, Code 5258. Under Code 5259, symptomatic

removal of semilunar cartilage warrants a 10 percent evaluation. 38 C.F.R. § 4.71a, Code 5259.

Separate ratings may be assigned for compensable limitation of both flexion and

extension, or for limitation of motion and instability or subluxation of the knee, or

meniscal pathology. However, a separate rating can only be assigned where

additional compensable symptomatology is shown that is not duplicative of that

used to assign another rating. 38 C.F.R. § 4.14.

Code 5257 was amended in February 2021 to provide ratings for recurrent subluxation or lateral instability, and to essentially define the previously undefined terms such as mild, moderate, and severe instability. The revised regulations provide a 10 percent rating is warranted for sprain, incomplete ligament tear, or complete ligament tear (repaired, unrepaired, or failed repair) causing persistent instability, without a prescription from a medical provider for an assistive device (e.g., cane(s), crutch(es), walker) or bracing for ambulation. A 20 percent rating is warranted for either (a) sprain, incomplete ligament tear, or repaired complete ligament tear causing persistent instability, and a medical provider prescribing a brace and/or assistive device (e.g., cane(s), crutch(es), walker) for ambulation; or (b) unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribing either an assistive device (e.g., cane(s), crutch(es), walker) or bracing for ambulation. A 30 percent rating is warranted for unrepaired or failed repair of complete ligament tear causing persistent instability and a medical provider prescribing both an assistive device (e.g., cane(s), crutch(es), walker) and bracing for ambulation.

The amended Diagnostic Code 5257 also provides for ratings based on patellar

instability. A 10 percent rating is warranted for a diagnosed
/or assistive device (e.g., cane(s), crutch(es), walker) for ambulation; or (b) unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribing either an assistive device (e.g., cane(s), crutch(es), walker) or bracing for ambulation. A 30 percent rating is warranted for unrepaired or failed repair of complete ligament tear causing persistent instability and a medical provider prescribing both an assistive device (e.g., cane(s), crutch(es), walker) and bracing for ambulation.

The amended Diagnostic Code 5257 also provides for ratings based on patellar

instability. A 10 percent rating is warranted for a diagnosed condition involving the patellofemoral complex with recurrent instability (with or without history of

surgical repair) that does not require a prescription from a medical provider for a

brace, cane, or walker. A 20 percent rating is warranted for a diagnosed condition

involving the patellofemoral complex with recurrent instability after surgical repair

that requires a prescription by a medical provider for one of the following: a brace,

cane, or walker. A 30 percent rating is warranted for a diagnosed condition

involving the patellofemoral complex with recurrent instability after surgical repair

that requires a prescription by a medical provider for a brace and either a cane or a

walker. Note [1] to Code 5257 states that for patellar instability, the patellofemoral

complex consists of the quadriceps tendon, the patella, and the patellar tendon.

Note [2] to Code 5257 states that a surgical procedure that does not involve repair of one or more patellofemoral components that contribute to the underlying instability shall not qualify as surgical repair for patellar instability (including, but not limited to, arthroscopy to remove loose bodies and joint aspiration.

Diagnostic Codes 5258, 5259, 5260 and 5261, applicable to meniscal conditions

and limitation of motion in the knee, were unchanged by the February 2021

amendments.

The rating criteria of Diagnostic Code 5003, pertaining to degenerative arthritis,

were revised to clarify that this Code pertains to degenerative arthritis other than

post-traumatic.

Separate disability ratings are possible for arthritis with limitation of motion under

DC 5003 (providing rating for arthritis) and instability of a knee under Code 5257.

VAOPGCPREC 23-97; 62 Fed. Reg. 63,604 (1997). When X-ray findings of

arthritis are present and a Veteran's knee disability is rated under Code 5257, the

Veteran would be entitled to a separate compensable rating under Code 5003 if the

arthritis results in noncompensable limitation of motion and/or objective findings

or indicators of pain. See VAOPGCPREC 9-98, 63 Fed. Reg. 56,703 (1998).

A March 2025 VA treatment record notes that the Veteran had bilateral knee arthritis and that knee braces were ordered.

On June 2025 VA knee examination, bilateral knee strain, bilateral knee arthritis, and bilateral knee arthrosis were diagnosed. The Veteran reported that he was currently experiencing gradually worsening achy, popping, knee pain. He related that he used Diclofenac cream and prescribed pain medication. The Veteran reported that he had difficulty with bending, climbing, and ascending and descending steps. He related that he had difficulty with walking and standing for prolonged periods of time, was unable to kneel or squat, and had difficulty with household chores or yard work. The Veteran reported that flare-ups of his right and left knees occurred once a month, were moderate in severity, and lasted for up to two weeks per episode. He related that the flare-ups were precipitated by turning or positioning the wrong way, standing or walking for prolonged periods of time, and cold weather. The Veteran did not report a history of instability or subluxation. He related that he experienced bilateral knee swelling once a month. The examiner noted that the bilateral knee ROM contributed to functional loss.

Right and left knee ROM testing showed flexion to 120 degrees and extension to 5 degrees. There was pain on extension and flexion bilaterally. Passive ROM was the same as active ROM. The Veteran experienced pain on weight-bearing, non-weight-bearing, active motion, and passive motion that caused functional loss. The functional loss was described as difficulty with bending, climbing, ascending and descending steps, walking and standing for prolonged periods of time, and an inability to kneel or squat. There was evidence of crepitus in both knees and moderate tenderness to the medial knee in both knees. The Veteran could perform repetitive use testing with no additional loss of function or ROM. He was not being examined immediately after repeated use over time, and the examiner indicated that procured evidence suggested that pain and lack of endurance significantly limited functional ability with repeated use over time. The estimated ROM after repeated use over time was flexion to 110 degrees and extension to 5 degrees, bilaterally. The Veteran was not being examined during a flare-up, and procured evidence suggested that pain and lack of endurance significantly limited functional ability with flare-ups. The estimated ROM during a flare-up was flexion to 105 degrees and extension to 10 degrees, bilaterally. Additional factors contributing to disability included interference with standing, swelling, disturbance of locomotion in both knees and also weakened movement in the left knee. No muscle atrophy was shown, and no ankylosis was shown. There was recurrent subluxation or persistent instability in each knee. Joint stability testing showed that there was slight recurrent subluxation of the right knee and slight recurrent subluxation of the left knee. There were no ligament tears or sprains in either knee. The examiner indicated that the Veteran required a prescription for a cane for both knees. There was no patellar instability in either knee and no meniscal conditions in either knee. It was noted that the Veteran had not undergone surgical procedures for either knee. He reported that he used a cane for his bilateral knee instability.

Regarding functional impact, the examiner indicated that the Veteran had difficulty with walking and standing for prolonged periods of time and that he experienced knee swelling during flare-ups which was caused by prolonged standing and walking. It was noted that the Veteran's bilateral knee conditions, including right and left knee instability, strain, osteoarthritis, and degenerative arthritis, contribute to chronic joint pain, reduced range of motion, crepitus, and episodes of giving way or buckling. The examiner indicated that such impairments significantly affected the Veteran's ability to engage in occupational activities that required prolonged standing, walking, climbing stairs, kneeling, squatting, or carrying/lifting objects. It was noted that functional limitations included difficulty with weight-bearing tasks, limited endurance for ambulation or standing, and increased risk of falls due to instability. The examiner indicated that the Veteran may require frequent rest periods or assistive devices (e.g., braces, cane) to maintain mobility and safety and that such limitations interfere with the ability to perform physically demanding job duties and may also impact roles that require dynamic postural changes or rapid movement. She noted that the cumulative effect of these conditions may necessitate workplace accommodations, such as modified duties or a sedentary environment with ergonomic support.

In a February 2026 vocational assessment, the provider indicated that she conducted a telephone interview with the Veteran, and he described symptoms of difficulty with prolonged standing, walking, and sitting, having to constantly change positions to achieve comfort, and pain and instability while ambulating, which he asserted had been present since at least June 2014. He reported intense back and knee pain that caused him issues with prolonged standing, walking, and sitting. The Veteran related that he often has to have help from his wife to rise from the bed in the morning due to his elevated levels of pain. He also reported that he was no longer able to do yard work.

Right and left knee strain

The Board finds that the persuasive weight of the evidence is against ratings in excess of 10 percent for limitation of extension for the right and left knees under Diagnostic Code 5261. Here, a VA examination of the knees, conducted in June 2025, disclose that the Veteran demonstrated extension of the left and right knees that were limited, at most to 10 degrees, to include the estimated ROM due to bilateral knee flare-ups. Thus, because the Veteran has not shown that he has had extension of either the left or right knee limited to 15 degrees at any time during the appeal period, 20 percent ratings for either the left or right
that he was no longer able to do yard work.

Right and left knee strain

The weight of the evidence is also against the assignment of a separate compensable rating for either the left and/or right knees under Code 5260, the Code governing limitation of flexion of the knee. In order to warrant a 10 percent rating under Code 5260, knee flexion must be functionally limited to 45 degrees. Here, on June 2025 VA examination, flexion of the of the left and right knees were limited, at most, to 105 degrees, bilaterally. Thus, the criteria for a separate compensable rating under Code 5260 for either the left or right knee have not been met at any time during the appeal period.

The Board emphasizes that the objective medical findings of record do not reflect any findings of additional right or left knee limitation of extension, even considering the limitations of function and motion noted on the June 2025 knee examination report. Although the June 2025 knee examination report reflects pain on weight-bearing, non-weight-bearing, active motion, and passive motion that caused functional loss there are no findings of pain or other manifestations or functional impairments causing additional limitation of right or left or right knee extension to 15 degrees or more, left or right knee flexion to 45 degrees or less, or any findings that are akin to ankylosis of the right or left knees.

As noted above, right and/or left knee ankylosis was not shown on examination. Although the Veteran reported that he did have to rest after extended periods of walking or weight bearing, and that his knees would swell, stiffen, and become painful, repetitive motion testing did not cause additional limitation of motion beyond what was shown on active testing. As such, even considering the Veteran's competent and credible reports of pain and functional limitations with flare ups of the right and left knees, the estimated ranges of motion when considering such flare-ups, would not warrant a higher rating for either knee.

Thus, in considering the June 2025 knee examination report and the Veteran's complaints of pain and reported limitations on examination on in the February 2026 vocational assessment, in conjunction with 38 C.F.R. § 4.40, 4.45, 4.59, and consistent with the decision in DeLuca v. Brown, 8 Vet. App. 202 (1995), the Board finds the evidence does not support the assignment of higher disability ratings in excess of the 10 percent rating currently assigned for the left and right knee disabilities at any point during the appeal period. Id; see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Therefore the claims seeking ratings in excess of 10 percent for right and left knee strain are denied.

Right and left knee instability

The Board finds that the persuasive weight of the evidence does not support ratings in excess of 10 percent for the Veteran's right and left knee instability under the rating criteria for Code 5257. Throughout the period on appeal, the Veteran has reported use of prescribed knee braces and difficulty with ambulating and rising from bed in the morning. However, on June 2025 VA examination, although there was recurrent subluxation or persistent instability in each knee, joint stability testing showed that there was slight recurrent subluxation of the right knee and slight recurrent subluxation of the left knee. There were no ligament tears or sprains in either knee. Additionally, although the examiner indicated that the Veteran required a prescription for a cane for both knees, there was no patellar instability in either knee and no meniscal conditions in either knee. It was noted that the Veteran had not undergone surgical procedures for either knee, and he reported that he used a cane for his bilateral knee instability.

Although the current VA examination did not find right knee recurrent patellar instability, a 10 percent rating is still warranted for right knee instability because he has been prescribed a cane for both knees. As noted above, while the Board observes that the Veteran has been prescribed a cane for his left
recurrent subluxation of the left knee. There were no ligament tears or sprains in either knee. Additionally, although the examiner indicated that the Veteran required a prescription for a cane for both knees, there was no patellar instability in either knee and no meniscal conditions in either knee. It was noted that the Veteran had not undergone surgical procedures for either knee, and he reported that he used a cane for his bilateral knee instability.

Although the current VA examination did not find right knee recurrent patellar instability, a 10 percent rating is still warranted for right knee instability because he has been prescribed a cane for both knees. As noted above, while the Board observes that the Veteran has been prescribed a cane for his left and right knees, the record does not show evidence of either right and/or left knee sprain, incomplete or complete ligament tear or a diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair (italics added for emphasis) to support 20 percent ratings for either knee under DC 5257 rating criteria at any time during the appeal period. Therefore, due to the foregoing, the Board finds that ratings in excess of 10 percent for right and left knee instability are not warranted, and the claims seeking ratings in excess of 10 percent for right and left knee instability are denied.

Recently the U.S. Court of Appeals for Veterans Claims (CAVC) issued a precedential decision in Ingram v. Collins, 38 Vet. App. 130 (2025), which indicated that when the Board evaluates musculoskeletal disabilities where the relevant Diagnostic Code does not reference medication use, the Board must discount beneficial medication effects and evaluate the baseline severity of each disability. The Board observes that on June 2025 VA knee examination, the Veteran reported that he used a topical cream (Diclofenac) and prescribed pain medication, which he did not name.

The Board is cognizant of the fact that the Veteran has used a topical cream and pain medication to treat his knee pain but notes, however, that Ingram does not address how the Board is to discount the beneficial effects of medication, particularly when used as treatment for musculoskeletal symptoms and where examiners do not reasonably have the ability to assess range of motion both with and without use of medication. Moreover, in this case, the VA examiner, in rendering range of motion findings, noted and considered the Veteran's lay statements describing functional limitations when his pain and functional impairment is at its worst (e.g., during flare ups, on repetitive motion, due to lack of endurance, and lack of coordination, etc.). On examination, the Veteran did not report how often he used the topical cream, the name of his prescription pain medication, or how often he took the pain medication, but in any case, it is clear the examiner already provided an opinion estimating range of motion findings and considered the Veteran's description of when his pain is at its worst. As such, the Board finds the report and the remainder of the evidentiary record adequate to base a decision, resolving all reasonable doubt in the Veteran's favor.

7. An effective date prior to March 31, 2025, for the award of service connection for right lower extremity sciatic nerve radiculopathy is denied.

8. An earlier effective date of October 25, 2022, for the award of service connection for left lower extremity sciatic nerve radiculopathy is granted.

The Veteran has asserted that he is entitled to an effective date earlier than March 31, 2025, for the awards of service connection for right lower extremity sciatic radiculopathy and left lower extremity sciatic radiculopathy.

Generally, the effective date of an award based on an original claim, or a claim reopened after final adjudication, shall be fixed in accordance with the facts found, but shall not be earlier than the date of receipt of application. 38 U.S.C. § 5110 (a). Except as otherwise provided, the effective date of an award of compensation based on an original claim, a claim reopened after final disallowance, or a claim for increase, will be the date of receipt of the claim or the date entitlement arose, whichever is later. 38 C.F.R. § 3.400(a).

According to 38 C.F.R. § 3.400(o)(2), the effective date of an award of increased disability compensation shall be the earliest date as of which it is factually ascertainable that an increase in disability had occurred, if application is received within one year from such date; otherwise, the effective date will be the date of VA receipt of the claim for increase, or the date entitlement arose, whichever is later. Id.; see also 38 U.S.C. § 5110 (a),
disallowance, or a claim for increase, will be the date of receipt of the claim or the date entitlement arose, whichever is later. 38 C.F.R. § 3.400(a).

According to 38 C.F.R. § 3.400(o)(2), the effective date of an award of increased disability compensation shall be the earliest date as of which it is factually ascertainable that an increase in disability had occurred, if application is received within one year from such date; otherwise, the effective date will be the date of VA receipt of the claim for increase, or the date entitlement arose, whichever is later. Id.; see also 38 U.S.C. § 5110 (a), (b)(2); Hazan v. Gober, 10 Vet. App. 511 (1997); Harper v. Brown, 10 Vet. App. 125 (1997).

On June 13, 2014, VA received the Veteran's claim seeking service connection for his back disability, and he did not specify that he was seeking separate ratings for right and/or left lower extremity sciatic nerve radiculopathy.

A December 2018 VA treatment record notes that the Veteran reported back pain, and, on evaluation, no radicular pain was noted, and there was no loss of motor or sensory function.

An October 25, 2022, VA treatment record notes that the assessment was low back pain with mild left sciatica symptoms. The Veteran reported that he was about to go out of the country and was in need of a larger supply of medication for his sciatica.

A May 2023 VA treatment record notes that the assessment was low back pain with mild left sciatica symptoms.

A March 2024 VA treatment record notes that the Veteran had low back pain with mild left sciatica symptoms.

Service connection for right and left lower extremity sciatic radiculopathy was granted secondary to the Veteran's service-connected back disability in an April 2025 rating decision. Therefore, as noted above, the effective date is the date of receipt of the claim for the back disability (June 13, 2014) or date entitlement arose, whichever is later.

Earlier effective date for right lower extremity sciatic nerve radiculopathy.

Although there are notations of radiculopathy in the VA treatment records prior to March 31, 2025, such radiculopathy is noted as only involving the left lower extremity sciatic nerve, and prior to March 31, 2025, a diagnosis of right lower extremity sciatic nerve radiculopathy is not shown in the treatment records.

As the June 2014 claim was a claim seeking service connection for a back disability, the effective date for right lower extremity sciatic nerve radiculopathy will be the date the claim was received or the date entitlement arose, whichever is later. As noted above, an April 2025 rating decision granted service connection for right lower extremity sciatic nerve radiculopathy, effective March 31, 2025, the date of the VA examination in which right lower extremity sciatic nerve radiculopathy was first diagnosed. Accordingly, entitlement to a separate rating for right lower extremity sciatic nerve radiculopathy would have arisen on that day. Treatment records during the period on appeal prior to March 31, 2025, do reference radiculopathy at times, as noted above, but do not note a diagnosis of right lower extremity sciatic nerve radiculopathy (and a specific date of onset of right lower extremity sciatic nerve radiculopathy is not shown or alleged). The Board notes that right lower extremity sciatic nerve radiculopathy was not diagnosed until March 31, 2025. Therefore, an earlier effective date prior to March 31, 2025, for the award of service connection for right lower extremity sciatic nerve radiculopathy is not warranted.

Earlier effective date for left lower extremity sciatic nerve radiculopathy.

As noted above, because the June 2014 claim was a claim seeking service connection for a back disability, the effective date for left lower extremity sciatic nerve radiculopathy will be the date the claim was received or the date entitlement arose, whichever is later (emphasis added). An April 2025 rating decision granted service connection for left lower extremity sciatic nerve radiculopathy, effective March 31, 2025, the date of the VA examination in which left lower extremity sciatic nerve radiculopathy appeared to have been first diagnosed. However, a review of the record notes that symptoms of left lower extremity sciatic radiculopathy were first noted in an October 25, 2022, VA treatment record when a VA provider noted an assessment of low back pain with mild left sciatic nerve symptoms. Accordingly, entitlement to a separate rating for left lower extremity sciatic radiculopathy would have arisen on that day. Treatment records during the period on appeal prior to October 25, 2022, do not note a diagnosis of, or symptoms of, left lower extremity sciatic radiculopathy (and a specific date of onset of left lower extremity radiculopathy is not shown or alleged). While the law provides for an effective date as early as June 13, 2014, the date of claim for the back disability, the Board notes that symptoms of left lower extremity sciatic radiculopathy were not shown in the treatment records until October 25, 2022. Therefore, an earlier effective date of October 25, 2022, for the award of service connection for left lower extremity radiculopathy is warranted.

9. Entitlement to a rating in excess of 20 percent for right lower extremity sciatic nerve radiculopathy is denied.

10. A 10 percent rating for left lower extremity sciatic nerve radiculopathy is warranted prior to March 31, 2025, from the earlier effective date of October 25, 2022, subject to the regulations governing payment of monetary awards.

11. From March 31, 2025, a rating in excess of 20 percent for left lower extremity sciatic nerve radiculopathy is denied.

Disability evaluations are determined by the application of a schedule of ratings, which is based on average impairment of earning capacity caused by the given disability. Separate diagnostic codes identify the various disabilities. 38 C.F.R. § 1155; 38 C.F.R. Part 4.

When the appeal is from the initial rating assigned with a grant of service connection (as here, with the above claims), the severity of the disability during the entire period from the grant of service connection to the present is to be considered. "Staged" ratings may be assigned for distinct periods when different levels of impairment are shown. Fenderson v. West, 12 Vet. App. 119 (1999).

Throughout the period on appeal, the Veteran's right lower extremity sciatic nerve radiculopathy and left lower extremity sciatic nerve radiculopathy have each been rated at 20 percent under Code 8520 (for sciatic nerve paralysis), which sets forth the following criteria. A 10 percent rating is warranted for mild incomplete paralysis; a 20 percent rating is warranted for moderate incomplete paralysis; a 40 percent rating is warranted for moderately severe incomplete paralysis; a 60 percent rating is warranted for severe incomplete paralysis, with marked muscular atrophy; and an 80 percent rating is warranted for complete paralysis, where the foot dangles and drops, no active movement is possible of muscles below the knee, and flexion of the knee is weakened or (very rarely) lost. 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.124a, Code 8520.

The Board notes, for reference and illustrative purposes, that the definition for "mild" includes not very severe. WEBSTER'S II NEW COLLEGE DICTIONARY at 694 (1995). In addition, a synonym for "mild" is "slight," and definitions for "slight" include small in size, degree, or amount. Id. at 1038. The definitions for "moderate" include of average or medium quantity, quality, or extent. Id. at 704. Finally, definitions of "severe" include extremely intense. Id. at 1012. It is noted that the term "moderately severe" indicates impairment greater than moderate, but not to the extent as to be considered severe.

The Board also finds that 'mild"
. WEBSTER'S II NEW COLLEGE DICTIONARY at 694 (1995). In addition, a synonym for "mild" is "slight," and definitions for "slight" include small in size, degree, or amount. Id. at 1038. The definitions for "moderate" include of average or medium quantity, quality, or extent. Id. at 704. Finally, definitions of "severe" include extremely intense. Id. at 1012. It is noted that the term "moderately severe" indicates impairment greater than moderate, but not to the extent as to be considered severe.

The Board also finds that 'mild" corresponds to symptoms, however slight, sufficient to support a diagnosis of the peripheral nerve impairment for service connection purposes. In general, this level of severity is limited to sensory deficits that are lower graded, less persistent, or affecting a small area. A very minimal reflex or motor abnormality potentially could also be consistent with mild incomplete paralysis.

"Moderate" symptoms will likely be described by the claimants and medically graded as significantly disabling. In such cases, a larger area in the nerve distribution may be affected by sensory symptoms. Other sign/symptom combinations that may fall into the moderate category include combinations of significant sensory changes and reflex or motor changes of a lower degree, or motor and/or reflex impairment such as weakness or diminished or hyperactive reflexes (with or without sensory impairment) graded as medically moderate.

The "moderately severe" evaluation level is only applicable for involvement of the sciatic nerve. This is the maximum rating for sciatic nerve neuritis not characterized by the organic changes specified in 38 C.F.R. § 4.123. Motor and/or reflex impairment (for example, weakness or diminished or hyperactive reflexes) at a grade reflecting a high level of limitation or disability is expected. Atrophy may be present. However, for marked muscular atrophy, see the criteria for a "severe" evaluation under 38 C.F.R. § 4.124a, Code 8520.

Finally, the "severe" evaluation level 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. For the sciatic nerve (38 C.F.R. § 4.124a, Code 8520), marked muscular atrophy is expected. Even though severe incomplete paralysis cases should show findings substantially less than representative findings for complete impairment of the nerve, the disability picture for severe incomplete paralysis may contain signs/symptoms resembling some of those expected in cases of complete paralysis of the nerve. Neuritis characterized by loss of reflexes, muscle atrophy, sensory disturbances, and constant pain should be rated as high as severe incomplete paralysis of the nerve (38 C.F.R. § 4.123).

The term "incomplete paralysis," with respect to peripheral nerve injuries, indicates a degree of lost or impaired function substantially less than the type pictured for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. 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.

An October 2022 VA treatment record notes an assessment of low back pain with mild left sciatica symptoms.

A May 2023 VA treatment record notes an assessment of low back pain with mild left sciatica symptoms.

A March 2024 VA treatment record notes an assessment of low back pain with mild left sciatica symptoms.

On March 2025 VA back examination, muscle strength testing was 4/5 in hip and knee extension bilaterally and 5/5 in ankle plantar flexion, ankle dorsiflexion, and great toe extension bilaterally. Muscle atrophy was not shown. The reflex examination was normal. The sensory examination was normal in the bilateral upper thigh and decreased in the bilateral thigh/knee, lower leg/ankle, and foot/toes. The Veteran reported radicular pain. He related that he experienced severe intermittent pain in the right and left lower extremities, moderate paresthesia in the right and left lower extremities, and moderate numbness in the right and left lower extremities. The examiner noted that there was involvement of the sciatic nerve bilaterally.

On June 2025 VA back examination, muscle strength testing was 4/5 in both lower extremities except for great toe extension which was 5/5 bilaterally.
not shown. The reflex examination was normal. The sensory examination was normal in the bilateral upper thigh and decreased in the bilateral thigh/knee, lower leg/ankle, and foot/toes. The Veteran reported radicular pain. He related that he experienced severe intermittent pain in the right and left lower extremities, moderate paresthesia in the right and left lower extremities, and moderate numbness in the right and left lower extremities. The examiner noted that there was involvement of the sciatic nerve bilaterally.

On June 2025 VA back examination, muscle strength testing was 4/5 in both lower extremities except for great toe extension which was 5/5 bilaterally. Muscle atrophy was not shown. The sensory examination was normal. The reflex examination was 1+ in each area. The Veteran reported that he experienced radicular symptoms of severe intermittent pain in the right and left lower extremities, moderate paresthesia in the right and left lower extremities, and mild numbness in the right and left lower extremities. The examiner noted that there was involvement of the sciatic nerve bilaterally.

Throughout the period on appeal, the VA examination reports and VA treatment records do not show symptoms of, or impairment due to, right lower extremity sciatic nerve radiculopathy to have been of greater severity than that consistent with moderate incomplete paralysis of that nerve, so as to warrant a rating in excess of 20 percent for sciatic nerve involvement in the right lower extremity. As noted above, on March 2025 VA back examination, muscle strength testing was 4/5 in hip and knee extension bilaterally and 5/5 in ankle plantar flexion, ankle dorsiflexion, and great toe extension bilaterally, and on June 2025 VA back examination, muscle strength testing was 4/5 in both lower extremities except for great toe extension which was 5/5 bilaterally. Muscle atrophy was not shown on either examination. On March 2025 VA back examination, the sensory examination was normal in the bilateral upper thigh and decreased in the bilateral thigh/knee, lower leg/ankle, and foot/toes, and on June 2025 VA back examination, the sensory examination was normal. On both examinations, the Veteran reported severe intermittent pain and moderate paresthesia in his bilateral lower extremities. However, on March 2025 VA back examination, he reported moderate numbness in his bilateral lower extremities, and on June 2025 VA back examination, he reported mild numbness in his bilateral lower extremities. Although the Veteran reported lower extremity radicular pain on examination, the descriptions of functioning and examination findings do not show or suggest symptoms or impairment characteristic of moderately severe incomplete paralysis of the right sciatic nerve throughout the period on appeal. Accordingly, a rating in excess of 20 percent, for right lower extremity sciatic nerve radiculopathy is not warranted and the claim seeking a rating in excess of 20 percent for right lower extremity sciatic nerve radiculopathy is denied.

Upon review of the evidence, the Board finds that a 10 percent (but no higher) rating is warranted, prior to March 31, 2025, from the earlier effective date of October 25, 2022, for the Veteran's left lower extremity sciatic nerve radiculopathy. October 2022 to March 2024 VA treatment records show that the Veteran had low back pain with mild sciatic nerve symptoms. Other treatment records during that period do not show that the left lower extremity sciatic nerve radiculopathy had been manifested by moderate incomplete paralysis of the left sciatic nerve. Accordingly, a 10 percent, but no higher, rating is warranted for the left lower extremity sciatic nerve radiculopathy prior to March 31, 2025, from the earlier effective date of October 25, 2022.

From March 31, 2025, the VA examination reports and VA treatment records do not show symptoms of, or impairment due to, left lower extremity sciatic nerve radiculopathy to have been of greater severity than that consistent with moderate incomplete paralysis of that nerve, so as to warrant a rating in excess of 20 percent for sciatic nerve involvement in the left lower extremity. As noted above, on March 2025 VA back examination, muscle strength testing was 4/5 in hip and knee extension bilaterally and 5/5 in ankle plantar flexion, ankle dorsiflexion, and great toe extension bilaterally, and on June 2025 VA back examination, muscle strength testing was 4/5 in both lower extremities except for great toe extension which
treatment records do not show symptoms of, or impairment due to, left lower extremity sciatic nerve radiculopathy to have been of greater severity than that consistent with moderate incomplete paralysis of that nerve, so as to warrant a rating in excess of 20 percent for sciatic nerve involvement in the left lower extremity. As noted above, on March 2025 VA back examination, muscle strength testing was 4/5 in hip and knee extension bilaterally and 5/5 in ankle plantar flexion, ankle dorsiflexion, and great toe extension bilaterally, and on June 2025 VA back examination, muscle strength testing was 4/5 in both lower extremities except for great toe extension which was 5/5 bilaterally. Muscle atrophy was not shown on either examination. On March 2025 VA back examination, the sensory examination was normal in the bilateral upper thigh and decreased in the bilateral thigh/knee, lower leg/ankle, and foot/toes, and on June 2025 VA back examination, the sensory examination was normal. On both examinations, the Veteran reported severe intermittent pain and moderate paresthesia in his bilateral lower extremities. However, on March 2025 VA back examination, he reported moderate numbness in his bilateral lower extremities, and on June 2025 VA back examination, he reported mild numbness in his bilateral lower extremities. Although the Veteran reported lower extremity radicular pain on examination, the descriptions of functioning and examination findings do not show or suggest symptoms or impairment characteristic of moderately severe incomplete paralysis of the left sciatic nerve throughout the period on appeal. Accordingly, a rating in excess of 20 percent, for left lower extremity sciatic nerve radiculopathy is not warranted and the claim seeking a rating in excess of 20 percent for left lower extremity sciatic nerve radiculopathy is denied.

In July 2024, the U.S. Court of Appeals for Veterans Claims (CAVC) held that the assignment of ratings based on paralysis does not preclude separate ratings for neuritis or neuralgia of the same nerve. Banschbach v. McDonough, 37 Vet. App. 422, 429 (2024). The CAVC explained that each nerve has a diagnostic code and rating scale for paralysis, as well as additional diagnostic codes (but no ratings) for "neuritis" and "neuralgia." The CAVC acknowledged that adjudicators must avoid pyramiding, i.e., evaluation of the same disability under various diagnoses. However, the CAVC noted that the rating schedule provides that separate conditions or manifestations of the same condition are to be rated separately, unless otherwise provided by the rating schedule. See 38 C.F.R. § 4.25(b). Moreover, the CAVC concluded that the Board must exhaust all schedular alternatives for rating a disability. See Morgan v. Wilkie, 31 Vet. App. 162, 168 (2019). The CAVC further noted that paralysis, neuritis, and neuralgia are uniquely defined, indicating that each may present separately ratable manifestations.

Regardless, no clinical evidence of record (private or VA) has diagnosed the Veteran with neuritis or neuralgia of the sciatic or femoral nerves of either lower extremity, such that separate ratings for either neuritis or neuralgia of the bilateral upper extremities are not for consideration here.

12. Entitlement to a TDIU rating is granted.

The Veteran asserts that his service-connected disabilities have rendered him unable to obtain and sustain substantially gainful employment.

In order to establish entitlement to a TDIU due to service-connected disabilities, there must be impairment so severe that it is impossible for the average person to follow a substantially gainful occupation. 38 U.S.C. §§1155;38C.F.R. §§3.340, 3.341, 4.16. In reaching such a determination, the central inquiry is "whether the Veteran's service-connected disabilities alone are of sufficient severity to produce unemployability." Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993).

Consideration may be given to the Veteran's level of education, special training, and previous work experience in arriving at a conclusion, but not to his or her age or to the impairment caused by nonservice-connected disabilities. 38 C.F.R. §§3.341, 4.16, 4.19; Van Hoose v. Brown,4 Vet. App. 361 (1993).

The phrase substantially gainful employment has two components: an economic one and a noneconomic one. Ray v. Wilkie, 31 Vet. App.
of sufficient severity to produce unemployability." Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993).

The phrase substantially gainful employment has two components: an economic one and a noneconomic one. Ray v. Wilkie, 31 Vet. App. 58 (2019). In assessing the Veteran's ability to secure and follow a substantially gainful occupation, the Board is to consider the Veteran's history, education, skill, and training as well as physical abilities and mental abilities required by the occupation at issue. Such specific physical ability-factors include lifting, bending, sitting, standing, walking, climbing, grasping, typing, reaching, auditory, and visual. Specific mental ability- factors include memory, concentration, ability to adapt to change, handle work- place stress, getting along with coworkers, and demonstrating reliability and productivity.

The regulatory scheme for a TDIU provides both objective and subjective criteria. Hatlestad, 5 Vet. App. 524; VAOPGCPREC 75-91 (Dec. 27, 1991) 57 Fed. Reg. 2317 (1992). The objective criteria, set forth at 38 C.F.R. §§ 3.340(a)(2), provide for a total rating when there is a single disability or a combination of disabilities that results in a 100 percent schedular evaluation. Subjective criteria, set forth at 38 C.F.R. §§4.16(a), provide for a TDIU when, due to service-connected disability, a Veteran is unable to secure or follow a substantially gainful occupation, and has a single disability rated 60 percent or more, or at least one disability rated 40 percent or more with additional disability sufficient to bring the combined evaluation to 70 percent. 38 C.F.R. §§3.340, 3.341, 4.16(a).

Marginal employment shall not be considered substantially gainful employment. For purposes of this section, marginal employment generally shall be deemed to exist when a Veteran's earned annual income does not exceed the amount established by the U.S. Department of Commerce, Bureau of Census, as the poverty threshold for one person. Marginal employment may also be held to exist, on a facts found basis (includes but is not limited to employment in a protected environment such as a family business or sheltered workshop), when earned annual income exceeds the poverty threshold. 38 C.F.R. § 4.16(a). The CAVC defined "employment in a protected environment" within 38 C.F.R. § 4.16(a) to unambiguously mean "a lower-income position that, due to the Veteran's service-connected disability or disabilities, is shielded in some respect from competition in the employment market." LaBruzza v. McDonough, 37 Vet. App. 111, 123-24 (2024).

During the period on appeal, the Veteran had an aggregated rating of 60 percent from June 13, 2014, and an 80 percent rating from March 31, 2025. The Veteran had the following service-connected disabilities: IVDS with degenerative arthritis (rated 20 percent from June 13, 2014, and 40 percent from March 31, 2025), right lower extremity sciatic nerve radiculopathy (rated 20 percent), left lower extremity sciatic nerve radiculopathy (rated 20 percent), tinnitus (rated 10 percent), right knee strain (rated 10 percent), left knee strain (rated 10 percent), right knee instability (rated 10 percent), left knee instability (rated 10 percent), bilateral hearing loss (rated 0 percent), and hypertension (rated 0 percent). Consequently, the Veteran met the schedular criteria for a TDIU during the period on appeal. 38 C.F.R. §4.16(a).

On March 2025 VA back examination, functional impact was described as an inability to walk over 300 yards without rest, stand for more than 5 minutes
knee instability (rated 10 percent), left knee instability (rated 10 percent), bilateral hearing loss (rated 0 percent), and hypertension (rated 0 percent). Consequently, the Veteran met the schedular criteria for a TDIU during the period on appeal. 38 C.F.R. §4.16(a).

On March 2025 VA back examination, functional impact was described as an inability to walk over 300 yards without rest, stand for more than 5 minutes without having to rest, an inability to lift any weight over 5 pounds, and an inability to walk without pain. The Veteran also indicated that navigating steps was very difficult.

On June 2025 VA back examination, the Veteran's functional impact was described as difficulty with bending, squatting, kneeling, and lifting. It was also noted that he was unable to walk or stand for prolonged periods without having to rest and that such conditions impaired his ability to perform tasks that required prolonged standing, walking, sitting, or repetitive movements. The Veteran's functional limitations included difficulty with lifting, bending, twisting, and maintaining postural positions for extended periods of time. The examiner noted that he might require frequent position changes and might be unable to perform physically demanding tasks, which could significantly impact requiring manual labor, prolonged activity, or static postures.

On June 2025 VA knee examination, it was noted that the Veteran's bilateral knee impairments significantly affected his ability to engage in occupational activities that required prolonged standing, walking, climbing stairs, kneeling, squatting, or carrying/lifting objects. His functional limitations included difficulty with weight-bearing tasks, limited endurance for ambulation or standing, and increased risk of falls due to instability. The examiner indicated that the Veteran might require frequent rest periods or assistive devices (e.g., braces, cane) to maintain mobility and safety. It was noted that such limitations interfered with the Veteran's ability to perform physically demanding job duties and might also impact roles that required dynamic postural changes or rapid movement. The examiner also indicated that the cumulative effect of these conditions might necessitate workplace accommodation, such as modified duties or a sedentary environment with ergonomic support.

In a February 2026 vocational assessment, the provider indicated that she conducted a telephone interview with the Veteran and that he described symptoms of difficulty with prolonged standing, walking, and sitting, having to constantly change positions to achieve comfort, having pain and instability while ambulating, difficulty communicating with others due to hearing loss, and difficulty maintaining attention and concentration due to a combination of symptoms that have been present since at least June 2014. He reported intense back and knee pain that caused him to have difficulty with prolonged standing, walking, and sitting. The Veteran related that he often had to have help from his wife to rise from the bed in the morning due to his elevated levels of pain. He reported that he was no longer able to do yard work and that during flare-ups of back pain, he was limited to lying in bed and was unable to stand or walk for a few minutes due to the pain.

The provider indicated that she reviewed the claims file and noted that the record was consistent with an individual who was disabled and more likely than not unable to secure and follow substantially gainful employment since at least June 2014 due to his service-connected disabilities. She noted that that sedentary work was defined as work that involved exerting up to 10 pounds of force occasionally (an activity or condition that exists up to 1/3 of the time) and/or a negligible amount of force frequently (an activity or condition that exists from 1/3 to 2/3 of the time) to lift carry, push, pull, or otherwise move objects, including the human body. The provider noted that sedentary work involved sitting most of the time but may involve walking or standing for brief periods of time. She indicated that jobs were sedentary if walking and standing were required only occasionally and all other sedentary criteria were met. The provider noted that even sedentary work required standing and walking up to occasionally, or up to one-third of the workday, as well as sitting most of the time. Therefore, it was her opinion that the Veteran's inability to perform prolonged standing and walking due to his service-connected conditions has precluded him from performing even sedentary work since at least June 2014.

The provider indicated that the October 2020, October 2023, and March 2025 examinations noted that the Veteran had difficulty walking for long distances, standing for prolonged periods of time, and
time. She indicated that jobs were sedentary if walking and standing were required only occasionally and all other sedentary criteria were met. The provider noted that even sedentary work required standing and walking up to occasionally, or up to one-third of the workday, as well as sitting most of the time. Therefore, it was her opinion that the Veteran's inability to perform prolonged standing and walking due to his service-connected conditions has precluded him from performing even sedentary work since at least June 2014.

The provider indicated that the October 2020, October 2023, and March 2025 examinations noted that the Veteran had difficulty walking for long distances, standing for prolonged periods of time, and difficulty lifting anything over five pounds or walking without pain. The provider noted that basic requirements for maintaining substantially gainful employment included an ability to maintain and sustain focus and attention for at least 2 hours at a time throughout the workday. The worker must also attend to their work and not require supervision or redirection to remain on task. The worker must also be able to follow short and simple instructions and recall work tasks without reminders. The worker cannot take unscheduled breaks or leave the workstation, except at designated break times. The worker must be able to interact appropriately with other coworkers, supervisors, and members of the public. Anger, irritability, and physical outbursts are not tolerated in competitive work. The worker must attend work on a regular schedule, free from excessive absences or tardiness. The provider noted that the maximum allowable absence tolerance by most employers was one day per month and that the worker must consistently produce a certain, minimal amount of work while on the job. She opined that it was more likely than not that the Veteran would be unable to satisfy most, if not all, of the basic requirements due to the combination of symptoms from his service-connected conditions. The provider noted that, per industry standards, employers will only allow an individual to be off task up to 10 percent of the workday, and employees are expected to maintain focus on work tasks for at least two consecutive hours. She believed that the Veteran would exceed that tolerance as a result of his symptoms related to his service-connected conditions. The provider indicated that his back pain, knee pain, swelling, instability, and chronic sleep impairment with daytime fatigue, would cause him to become distracted from work throughout the day, leading to excessive time off task. Specifically, his concentration impairment would preclude him from retaining information. For these reasons, the Veteran would not be considered a reliable and productive employee, and as a result, he would not be able to maintain employment due to an inability to meet competitive standards of work. In addition, his service-connected symptoms negatively impact his ability to learn new skills due to impairments in concentration.

The Board finds that the evidence of record persuasively and reasonably shows that the Veteran's service-connected disabilities (both compensable and non-compensable) have been such that they preclude him from maintaining regular, substantially gainful employment. Regarding his back and knee disabilities, VA and private providers have indicated that he would have issues with prolonged standing, walking, climbing stairs, kneeling, squatting, or carrying/lifting objects. His functional limitations included difficulty with weight-bearing tasks, limited endurance for ambulation or standing, and increased risk of falls due to instability. A June 2025 VA examiner indicated that the Veteran might require frequent rest periods or assistive devices (e.g., braces, cane) to maintain mobility and safety. It was noted that such limitations interfered with the Veteran's ability to perform physically demanding job duties and might also impact roles that required dynamic postural changes or rapid movement. The examiner also indicated that the cumulative effect of these conditions might necessitate workplace accommodation, such as modified duties or a sedentary environment with ergonomic support. The June 2026 private provider indicated that the Veteran's back pain, knee pain, swelling, instability, and chronic sleep impairment with daytime fatigue, would cause him to become distracted from work throughout the day, leading to excessive time off task. Specifically, his concentration impairment would preclude him from retaining information. For these reasons, the Veteran would not be considered a reliable and productive employee, and as a result, he would not be able to maintain employment due to an inability to meet competitive standards of work. Although no competent clinician has indicated that the Veteran's service-connected disabilities would prohibit all forms of employment, the Board finds that after evaluating the impact of the Veteran's disabilities as a whole, it is reasonably shown that the Veteran's service-connected disabilities have resulted in functional limitations incompatible with regular substantially gainful employment. The back, knees, radiculopathy, and hearing disabilities, combined, cause a severe impact on the Veteran's ability to sit, push,
. Specifically, his concentration impairment would preclude him from retaining information. For these reasons, the Veteran would not be considered a reliable and productive employee, and as a result, he would not be able to maintain employment due to an inability to meet competitive standards of work. Although no competent clinician has indicated that the Veteran's service-connected disabilities would prohibit all forms of employment, the Board finds that after evaluating the impact of the Veteran's disabilities as a whole, it is reasonably shown that the Veteran's service-connected disabilities have resulted in functional limitations incompatible with regular substantially gainful employment. The back, knees, radiculopathy, and hearing disabilities, combined, cause a severe impact on the Veteran's ability to sit, push, pull, carry, stand, or walk at a place of employment during a normal workday, especially since they individually cause him to be unable to stand, walk, or sit effectively for more than a few minutes at a time.

Resolving remaining reasonable doubt in the Veteran's favor, as required (see 38 C.F.R. § 4.3), the Board finds that a TDIU rating is warranted.

[The effective date of the award is a downstream issue for the Agency of Original Jurisdiction to address in the first instance.]

John R. Doolittle, II

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Bayles, James J.

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

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