07-19 676
07-19 676
| Board of Vet. App. | Jul 31, 2017Background
- Veteran served Sept 1999–Sept 2003 and appealed VA regional office ratings for lumbar degenerative disc disease (DD) and bilateral lumbar radiculopathy.
- Procedural history: service connection and initial ratings assigned (spine and left radiculopathy), RO increases and Board remands; DRO raised lumbar spine and left radiculopathy ratings effective Sept 21, 2015; right radiculopathy granted effective Sept 21, 2015.
- Key medical evidence: serial VA and private exams (2006, 2008, 2011, 2015) showing lumbar DDD/spondylolisthesis, limited forward flexion generally >30° prior to 9/21/15, functional loss with pain and decreased ROM after repetition by 9/21/15, and documented L5 radiculopathy on EMG for the left; right-sided findings first noted in 9/2015 exam.
- Ratings at issue: prior to 9/21/15 — 20% for lumbar spine and 10% left radiculopathy; since 9/21/15 — 40% lumbar spine and 20% left radiculopathy; right radiculopathy 10% initially.
- Board’s factual findings: prior to 9/21/15 spine showed painful limitation but ROM >30° flexion; since 9/21/15 no unfavorable ankylosis and no physician-prescribed bed rest; left radiculopathy mild before 9/21/15 and moderate thereafter; right radiculopathy mild.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| 1. Rating >20% for lumbar spine prior to 9/21/15 | Spine more limiting (pain/flareups, functional loss) warrants >20% | Objective ROM and exams show forward flexion >30° and no incapacitating episodes or ankylosis | Denied — pre-9/21/15 disability no more than 20% |
| 2. Rating >40% for lumbar spine from 9/21/15 | Post-9/21/15 functional loss and pain justify >40% (or 60% via incapacitating episodes) | No unfavorable ankylosis, no physician-prescribed bed rest, and no incapacitating episodes totaling ≥6 weeks | Denied — 40% appropriate; no basis for >40% |
| 3. Initial rating >10% for left lower extremity radiculopathy prior to 9/21/15 | Left radiculopathy caused more than mild paralysis (sensory + weakness) | Examinations showed principally sensory findings and minimal motor loss prior to 9/21/15 | Denied — no more than mild incomplete paralysis (10%) pre-9/21/15 |
| 4. Initial rating >20% for left lower extremity radiculopathy from 9/21/15 | Post-9/21/15 symptoms and decreased strength support >20% | 9/2015 exam supports moderate incomplete paralysis but not moderately severe or severe | Denied — 20% (moderate) appropriate from 9/21/15 |
| 5. Rating >10% for right lower extremity radiculopathy | Right-side symptoms warrant >10% | Right-side findings are mild on record (first noted 9/2015) with preserved strength | Denied — no more than mild incomplete paralysis (10%) |
Key Cases Cited
- Scott v. McDonald, 789 F.3d 1375 (Fed. Cir. 2015) (VA’s duty to assist and development obligations)
- McLendon v. Nicholson, 20 Vet. App. 79 (Vet. App. 2006) (standards for VA examinations)
- Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (Vet. App. 2008) (examiner must review records and provide rationale)
- DeLuca v. Brown, 8 Vet. App. 202 (Vet. App. 1995) (functional loss from pain under §§4.40/4.45)
- Johnston v. Brown, 10 Vet. App. 80 (Vet. App. 1997) (pain-based functional loss requires adequate pathology and observable behavior)
- Mitchell v. Shinseki, 25 Vet. App. 32 (Vet. App. 2011) (pain alone does not equal functional loss absent impact on work-related movement)
- Fenderson v. West, 12 Vet. App. 119 (Vet. App. 1999) (consider severity over entire period from initial rating)
- AB v. Brown, 6 Vet. App. 35 (Vet. App. 1993) (claimant presumed to seek highest rating)
- Gilbert v. Derwinski, 1 Vet. App. 49 (Vet. App. 1990) (benefit of the doubt rule application)
- Alemany v. Brown, 9 Vet. App. 518 (Vet. App. 1996) (standard for benefit of the doubt when evidence is in equipoise)
- Yancy v. McDonald, 27 Vet. App. 484 (Vet. App. 2016) (extraschedular referral not required unless raised by claimant or facts)
- Doucette v. Shulkin, 28 Vet. App. 366 (Vet. App. 2017) (no Board obligation to analyze extraschedular rating where not reasonably raised)
- Correia v. McDonald, 28 Vet. App. 158 (Vet. App. 2016) (limitations on retrospective testing for pain under §4.59)
- Rice v. Shinseki, 22 Vet. App. 447 (Vet. App. 2009) (TDIU may be raised as separate or in rating context)