Citation Nr: 1322391 Decision Date: 07/12/13 Archive Date: 07/18/13 DOCKET NO. 05-39 128A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Waco, Texas THE ISSUES 1. Entitlement to an increased disability evaluation for the Veteran's cervical spine degenerative disc disease, currently evaluated as 20 percent disabling. 2. Entitlement to a disability evaluation in excess of 20 percent for the Veteran's lumbar spine degenerative joint disease for the period prior to November 8, 2012. 3. Entitlement to a disability evaluation in excess of 40 percent for the Veteran's lumbar spine degenerative joint disease for the period on and after November 8, 2012. 4. Entitlement to an increased disability evaluation for the Veteran's right hip bursitis, currently evaluated as 10 percent disabling. 5. Entitlement to a compensable disability evaluation for the Veteran's left ear hearing loss. 6. Entitlement to a disability evaluation in excess of 10 percent for the Veteran's right lower extremity sciatic neuropathy for the period prior to December 8, 2011. 7. Entitlement to a disability evaluation in excess of 20 percent for the Veteran's right lower extremity sciatic neuropathy for the period on and after December 8, 2011. 8. Entitlement to a total rating for compensation purposes based on individual unemployability (TDIU) for the period prior to December 8, 2011. REPRESENTATION Appellant represented by: Texas Veterans Commission WITNESSES AT HEARINGS ON APPEAL The Veteran and his spouse ATTORNEY FOR THE BOARD J. T. Hutcheson, Counsel INTRODUCTION The Veteran had active service from September 1974 to September 1977 and from November 1982 to August 1997. This matter came before the Board of Veterans' Appeals (Board) on appeal from a September 2004 rating decision of the Waco, Texas, Regional Office (RO) which proposed to reduce the disability evaluation for the Veteran's right lower extremity sciatic neuropathy from 10 percent to noncompensable and denied increased evaluations for his cervical spine degenerative disc disease, lumbar spine degenerative joint disease, right hip bursitis, and left ear hearing loss. In July 2005, the RO effectuated the proposed reduction as of October 1, 2005. In June 2007, the Board remanded the Veteran's appeal to the RO so that the Veteran could be afforded a videoconference hearing before a Veterans Law Judge. In April 2011, the Veteran was afforded the requested videoconference hearing before the undersigned Veterans Law Judge. A hearing transcript was prepared and incorporated into the record. In August 2011, the Board remanded the Veteran's appeal to the RO for additional action. In February 2013, the RO, in pertinent part, increased the evaluation for the Veteran's lumbar spine degenerative joint disease from 20 to 40 percent; effectuated that award as of November 8, 2012; determined that the reduction of the evaluation for his right lower extremity sciatic neuropathy from 10 percent evaluation to noncompensable effective as of October 1, 2005, was improper; increased the evaluation for that disability from 10 to 20 percent; granted a TDIU; and effectuated those awards as of December 8, 2011. The Board has reviewed both the physical claims files and the "Virtual VA" file so as to insure a total review of the evidence. That action requested by the August 2011 Board remand was accomplished and the case subsequently returned to the Board. See Stegall v. West, 11 Vet. App. 268, 271 (1998) (noting the Board's duty to "insure [the RO's] compliance" with the terms of its remand orders). The issues of the evaluation of the Veteran's right lower extremity sciatic neuropathy and entitlement to a TDIU for the period prior to December 8, 2011, are REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. The Department of Veterans Affairs (VA) will notify the Veteran if further action is required on his part. FINDINGS OF FACT 1. The Veteran's cervical spine degenerative disc disease has been objectively shown to be manifested by no more than functional limitation of motion due to pain of forward flexion to 15 degrees, extension to 15 degrees, right lateral flexion to 10 degrees, left lateral flexion to 20 degrees, and bilateral lateral rotation to 30 degrees; spinal tenderness; significant occupational impairment; and no incapacitating episodes over the preceding 12 months. 2. Prior to November 8, 2012, the Veteran's service-connected lumbar spine degenerative joint disease was objectively shown to be manifested by no more than functional limitation of motion due to pain of forward flexion to 10 degrees, extension to 20 degrees, bilateral lateral flexion to 20 degrees, and bilateral lateral rotation to 20 degrees; kyphosis; lumbar flattening; and significant occupational impairment. 3. On and after November 8, 2012, the Veteran's lumbar spine degenerative joint disease has been objectively shown to be manifested by no more than chronic radiating low back pain; functional limitation of motion due to pain of forward flexion to 10 degrees, extension to 10 degrees, bilateral lateral flexion to 15 degrees, and bilateral lateral rotation to 20 degrees; tenderness; guarding or muscle spasm; an abnormal gait; abnormal spinal contour; and significant occupational impairment. 4. The Veteran's right hip bursitis has been shown to be objectively manifested by no more than chronic right hip pain; functional limitation of motion due to pain of flexion to 100 degrees and extension to "greater than 5" degrees with pain at 5 degrees; the ability to perform abduction beyond 10 degrees, to cross his right leg over his left and to toes out greater than 15 degrees; and pain with motion. 5. The Veteran's left ear hearing loss has been objectively shown to be manifested by no more than Level II auditory acuity. CONCLUSIONS OF LAW 1. The criteria for a 30 percent evaluation for the Veteran's cervical spine degenerative disc disease have been met. 38 U.S.C.A. §§ 1155, 5103, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.159, 3.321(b)(1), 3.326(a), 4.10, 4.40, 4.45, 4.71a, Diagnostic Codes 5243 (2012). 2. The criteria for a 40 percent evaluation for the Veteran's lumbar spine degenerative joint disease for the period prior to November 8, 2012, have been met. 38 U.S.C.A. §§ 1155, 5103, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.159, 3.321(b)(1), 3.326(a), 4.10, 4.40, 4.45, 4.71a, Diagnostic Codes 5003, 5242 (2012). 3. The criteria for an evaluation in excess of 40 percent for the Veteran's lumbar spine degenerative joint disease for the period on and after November 8, 2012, have not been met. 38 U.S.C.A. §§ 1155, 5103, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.159, 3.321(b)(1), 3.326(a), 4.10, 4.40, 4.45, 4.71a, Diagnostic Codes 5003, 5242 (2012). 4. The criteria for an evaluation in excess of 10 percent for the Veteran's right hip bursitis have not been met. 38 U.S.C.A. §§ 1155, 5103, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.159, 3.321(b)(1), 3.326(a), 4.10, 4.40, 4.45, 4.71a, Diagnostic Codes 5003, 5019, 5251, 5152, 5253 (2012). 5. The criteria for a compensable evaluation for the Veteran's left ear hearing loss have not been met. 38 U.S.C.A. §§ 1155, 5103, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.159, 3.321(b)(1), 3.326(a), 4.85, Diagnostic Code 6100 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Duties to Notify and to Assist In Pelegrini v. Principi, 18 Vet. App. 112 (2004), the United States Court of Appeals for Veterans Claims (Court) held that a Veterans Claims Assistance Act of 2000 (VCAA) notice, as required by 38 U.S.C.A. § 5103(a), must (1) inform the claimant about the information and evidence not of record that is necessary to substantiate the claim; (2) inform the claimant about the information and evidence that VA will seek to provide; and (3) inform the claimant about the information and evidence the claimant is expected to provide. The notice must be provided to a claimant before the initial unfavorable RO decision on a claim for VA benefits. VA has issued several VCAA notices to the Veteran including a May 2004 notice which informed him of the evidence generally needed to support a claim of entitlement to an increased evaluation and effective date for such an award; what actions he needed to undertake; and how VA would assist him in developing his claims. The May 2004 VCAA notice was issued to the Veteran prior to the September 2004 rating decision from which the instant appeal arises. The Veteran's claims were readjudicated in the July 2005 statement of the case (SOC) and the supplemental statements of the case (SSOC) issued to the Veteran. VA has secured or attempted to secure all relevant documentation to the extent possible. The Veteran was afforded both two hearings before a VA Decision Review Officer (DRO) and a videoconference hearing before the undersigned Veterans Law Judge. Hearing transcripts were prepared and incorporated into the record. The Board has twice remanded the Veteran's appeal to the RO for additional action including affording the Veteran VA examinations to ascertain the nature and etiology of his cervical spine, lumbar spine, right hip, and left ear hearing loss disabilities. The Veteran was afforded December 2011 and November 2012 VA examinations. The examination reports are of record. To that end, when VA undertakes to either provide an examination or to obtain an opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The examination reports thereto reflect that all relevant testing was performed. The examiners noted reviewing the record and provided the requested opinions. The Board finds that there has been substantial compliance with its remand instructions and additional remand is not required. D'Aries v. Peake, 22 Vet. App. 97 (2008) (noting that substantial rather than strict compliance with the terms of a Board remand is required pursuant to Stegall v. West, 11 Vet. App. 268 (1998)). All identified and available relevant documentation has been secured to the extent possible. All relevant facts have been developed to the extent possible. There remains no issue as to the substantial completeness of the Veteran's claims. 38 U.S.C.A. §§ 5103, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R §§ 3.102, 3.159, 3.326(a) (2012). Any duty imposed on VA, including the duty to assist and to provide notification, has been met as set forth above. Quartuccio v. Principi, 16 Vet. App. 183 (2002); Mayfield v. Nicholson, 19 Vet. App. 103(2005), rev'd on other grounds, No. 05-7157 (Fed. Cir. Apr. 5, 2006); Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006); Shinseki v. Sanders, 129 S. Ct. 1696 (2009). In the circumstances of this case, additional efforts to notify or to assist the Veteran in accordance with the VCAA would serve no useful purpose. See Soyini v. Derwinski, 1 Vet. App. 540, 546 (1991) (strict adherence to requirements of the law does not dictate an unquestioning, blind adherence in the face of overwhelming evidence in support of the result in a particular case; such adherence would result in unnecessarily imposing additional burdens on VA with no benefit flowing to the Veteran); Sabonis v. Brown, 6 Vet. App. 426, 430 (1994) (remands which would only result in unnecessarily imposing additional burdens on VA with no benefit flowing to the Veteran are to be avoided). II. Spinal Disabilities The Veteran advances that his cervical spine degenerative disc disease and lumbar spine degenerative joint disease have progressively increased in severity and necessitated that he be medically retired from his employment as a maintenance worker with the United States Postal Service (USPS). A. Historical Review The service treatment records indicate that the Veteran was seen for cervical spine and lumbar spine complaints after an in-service motor vehicle accident. The report of a January 1998 VA examination for compensation purposes states that the Veteran was diagnosed with cervical spine degenerative disc disease and lumbosacral spine degenerative disc disease with pain and limitation of motion. In June 1998, the RO established service connection for both cervical spine degenerative disc disease and lumbar spine degenerative joint disease; assigned 20 percent and 10 percent evaluations for the disabilities, respectively; and effectuated the awards as of September 1, 1997. The report of a June 1999 VA examination for compensation purposes conveys that the Veteran was diagnosed with chronic lumbosacral strain with right lower extremity sciatic neuropathy. In September 1999, the RO recharacterized the Veteran's service-connected lumbar spine disability as lumbar spine degenerative joint disease with sciatic neuropathy; assigned a 20 percent evaluation for that disability; and effectuated the award as of July 27, 1998. In October 2002, the RO recharacterized the Veteran's service-connected lumbar spine disorder as lumbar spine degenerative joint disease evaluated as 20 percent disabling and right lower extremity sciatic neuropathy evaluated as 10 percent and effectuated the awards as of September 23, 2002. In September 2004, the RO proposed to reduce the evaluation for the Veteran's right lower extremity sciatic neuropathy from 10 percent to noncompensable. In July 2005, the RO effectuated the proposed reduction as of October 1, 2005. In February 2009, the RO granted a separate 10 percent evaluation for right upper extremity peripheral neuropathy associated with the Veteran's cervical spine degenerative disc disease; denied service connection for left upper extremity peripheral neuropathy; and effectuated the award as of April 10, 2008. In February 2013, the RO increased the evaluation for the Veteran's lumbar spine degenerative joint disease from 20 to 40 percent; effectuated that award as of November 8, 2012; determined that the reduction of the evaluation for his right lower extremity sciatic neuropathy from 10 percent evaluation to noncompensable effective as of October 1, 2005, was improper; increased the evaluation for that disability from 10 to 20 percent; granted a TDIU; and effectuated those awards as of December 8, 2011. In February 2013, the RO increased the evaluation for the Veteran's lumbar spine degenerative joint disease from 20 to 40 percent and effectuated that award as of November 8, 2012. B. Evaluations Disability evaluations are determined by comparing the Veteran's current symptomatology with the criteria set forth in the Schedule For Rating Disabilities. 38 U.S.C.A. § 1155 (West 2002); 38 C.F.R. Part 4 (2012). Degenerative arthritis established by X-ray findings will generally be rated on the basis of limitation of motion of the specific joint or joints involved. Degenerative arthritis of the spine is to be evaluated under the General Rating Formula for Diseases and Injuries of the Spine. 38 C.F.R. § 4.71a, Diagnostic Codes 5003, 5242 (2012). Intervertebral disc syndrome (preoperatively or postoperatively) is to be evaluated either under the General Rating Formula for Diseases and Injuries of the Spine or under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, whichever method results in the higher evaluation when all disabilities are combined under 38 C.F.R.§ 4.25. 38 C.F.R. § 4.71a, Diagnostic Code 5243 (2012). The General Rating Formula for Diseases and Injuries of the Spine directs that a 20 percent evaluation is warranted where there is either forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees; the combined range of motion of the thoracolumbar spine not greater than 120 degrees; the combined range of motion of the cervical spine not greater than 170 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 30 percent evaluation requires forward flexion of the cervical spine of 15 degrees or less or favorable ankylosis of the entire cervical spine. A 40 percent evaluation will be assigned for either unfavorable ankylosis of the entire cervical spine; forward flexion of the thoracolumbar spine 30 degrees or less; or favorable ankylosis of the entire thoracolumbar spine. A 50 percent evaluation is warranted for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent evaluation will be assigned for unfavorable ankylosis of the entire spine. Under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, a 20 percent evaluation requires incapacitating episodes having a total duration of at least two weeks but less than four weeks during the past 12 months. A 40 percent evaluation requires incapacitating episodes having a total duration of at least four weeks, but less than six weeks during the past 12 months. A 60 percent evaluation requires incapacitating episodes having a total duration of at least six weeks during the past 12 months. Associated objective neurologic abnormalities, including, but not limited to bowel or bladder impairment, are to be separately evaluated under an appropriate diagnostic code. For VA compensation purposes, normal forward flexion of the cervical spine is 0 to 45 degrees, extension is 0 to 45 degrees, left and right lateral flexion are 0 to 45 degrees, and left and right lateral rotation are 0 to 80 degrees. Normal forward flexion of the thoracolumbar spine is 0 to 90 degrees, extension is 0 to 30 degrees, left and right lateral flexion are 0 to 30 degrees, and left and right lateral rotation are 0 to 30 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 (2012). Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that evaluation. Otherwise, the lower evaluation will be assigned. 38 C.F.R. § 4.7 (2012). Disability of the musculoskeletal system is primarily the inability, due to damage or infection in the parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. It is essential that the examination on which ratings are based adequately portray the anatomical damage, and the functional loss, with respect to all these elements. The functional loss may be due to absence of part, or all, of the necessary bones, joints and muscles, or associated structures, or to deformity, adhesions, defective innervation, or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by visible behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion, and a part which becomes painful on use must be regarded as seriously disabled. 38 C.F.R. §§ 4.10, 4.40, 4.45 (2012); DeLuca v. Brown, 8 Vet. App. 202, 205 (1995). Evaluations shall be based as far as practicable, upon the average impairments of earning capacity with the additional proviso that the Secretary shall from time to time readjust this schedule of ratings in accordance with experience. To accord justice, therefore, to the exceptional case where the schedular evaluations are found to be inadequate, the Under Secretary for Benefits or the Director, Compensation and Pension Service, upon field station submission, is authorized to approve on the basis of the criteria set forth in this paragraph an extra-schedular evaluation commensurate with the average earning capacity impairment due exclusively to the service-connected disability or disabilities. The governing norm in these exceptional cases is: A finding that the case presents such an exceptional or unusual disability picture with such related factors as marked interference with employment or frequent periods of hospitalization as to render impractical the application of the regular schedular standards. 38 C.F.R. § 3.321(b)(1) (2012). 1. Cervical Spine At a July 2004 VA examination for compensation purposes, the Veteran complained of progressively worsening cervical spine radiating pain which was exacerbated by bending, stooping, and lifting objects heavier than five pounds. He reported that he occasionally needed assistance from his wife to dress in the morning. He denied any interference with his work as a USPS maintenance worker associated with his cervical spine. On examination of the cervical spine, the Veteran exhibited a range of motion of forward flexion to 40 degrees with pain from 10 to 35 degrees, extension to 25 degrees, bilateral lateral flexion to 30 degrees, and bilateral lateral rotation to 60 degrees; mild tenderness on palpation; and no muscle spasm. The examiner commented that "there is mild functional impairment secondary to this veteran's neck condition during acute flare ups only." The Veteran was diagnosed with mild cervical degenerative disc disease with no evidence of radiculopathy. At an April 2006 VA examination for compensation purposes, the Veteran complained of progressively worsening severe burning posterior neck pain and stiffness which was exacerbated by exertion. He reported that his employment with the USPS was limited by his inability to lift and to perform certain movements. He denied having experienced any periods of incapacitation in the preceding 12 months. On examination of the cervical spine, the Veteran exhibited a range of motion of forward flexion to 45 degrees with pain from 15 to 35 degrees, extension to 45 degrees with pain at 45 degrees, bilateral lateral flexion to 40 degrees, and bilateral lateral rotation to 60 degrees; and no muscle spasm, paraspinous muscle tenderness, or spinal curvature abnormalities. The Veteran was diagnosed with "neck strain secondary to minor degenerative disc disease, C5-7" with no evidence of radiculopathy. The examiner commented that "there is mild functional impairment secondary to this veteran's neck condition during acute flare ups." At a September 2006 hearing before a DRO, the Veteran testified that his chronic neck pain significantly limited all of his activities. He stated that he continued to work only as he had no other option. A June 2008 written statement from the USPS conveys that the Veteran's service-connected disabilities were manifested by considerable impairment of his ability to perform his vehicle maintenance duties due to pain and associated reduced arm strength. An undated Federal Employees Retirement System (FERS) Agency Certification of Reassignment and Accommodation Efforts received in May 2009 states that the severity of the Veteran's medical conditions prevented him from continuing with his Federal Government employment. At an October 2009 VA examination for compensation purposes, the Veteran reported that he had been medically retired due to his cervical spine disorder. On examination of the cervical spine, the Veteran exhibited a range of motion of flexion to 35 degrees, extension to 30 degrees, bilateral lateral flexion to 25 degrees, and bilateral lateral rotation to 50 degrees; pain with all motion; tenderness; muscle weakness; and right cervical sacrospinalis muscle spasm. The Veteran was diagnosed with cervical spine intervertebral disc syndrome. Clinical documentation dated in April 2010 treatment record from Beaumont Army Medical Center indicates that the Veteran complained of a decreased cervical spine range of motion. On examination, the Veteran exhibited a "significant decrease in range of motion of neck" with "the majority of the loss of range of motion as with extension as well as his lateral bending." The Veteran was diagnosed with a C5-8 herniated disc and cervical spine neuritis. Treating Army medical personnel discussed the need for a future anterior cervical discectomy. At the April 2011 videoconference before the undersigned Veterans Law Judge, the Veteran testified that his cervical spine disability had increased in severity; had necessitated his medical retirement; and forced him to stay home every day. He stated that he had been scheduled for cervical spine surgery and the procedure was subsequently postponed due to his repeated infection and the limited success thought to be achieved by the surgery. The Veteran's spouse testified that she had to assist the Veteran to dress in the morning due to his cervical spine pain. At a November 2012 VA examination for compensation purposes, the Veteran complained of radiating cervical spine pain which was exacerbated by bending and turning his head. He reported having experienced no incapacitating episodes over the preceding 12 months. On examination of the cervical spine, the Veteran exhibited a range of motion of forward flexion to 35 degrees with pain at 15 degrees, extension to 25 degrees with pain at 15 degrees, right lateral flexion to 15 degrees with pain at 10 degrees, left lateral flexion to 20 degrees with pain, and bilateral lateral rotation to 50 degrees with pain at 30 degrees and tenderness. The Veteran was diagnosed with cervical spine degenerative disc disease with radiculopathy. The examiner commented that the Veteran's cervical spine disorder would limit his ability to turn his neck and thus slow down his performance of vocational activities. The Board has reviewed the probative evidence of record including the Veteran's testimony and written statements on appeal. The weight of the evidence demonstrates that the Veteran's cervical spine degenerative disc disease has been manifested by no more than functional limitation of motion due to pain of forward flexion to 15 degrees, extension to 15 degrees, right lateral flexion to 10 degrees, left lateral flexion to 20 degrees, and bilateral lateral rotation to 30 degrees; spinal tenderness; significant occupational impairment; and no incapacitating episodes over the preceding 12 months. Such functional impairment merits assignment of a 30 percent evaluation under Diagnostic Code 5243. A separate 10 percent evaluation has been previously granted for right upper extremity peripheral neuropathy associated with the Veteran's cervical spine disability under the provisions of 38 C.F.R. §§ 4.71a, 4.124a, Diagnostic Codes 5243, 8515. The Veteran's cervical spine disability is productive of significant occupational impairment which, in part, necessitated his medical retirement from the USPS. The weight of the evidence does not demonstrate unfavorable ankylosis of the entire cervical spine or incapacitating episodes having a total duration of at least four weeks, but less than six weeks during the past 12 months and the Veteran's functional loss due to pain has been considered in the assignment of a 30 percent rating. The Board finds that a 30 percent evaluation and no higher is warranted for the Veteran's cervical spine degenerative disc disease at any point during the relevant period of time. 38 C.F.R. §§ 4.10, 4.40, 4.45, 4.71a, Diagnostic Code 5243 (2012); Hart v. Mansfield, 21 Vet. App. 505 (2007). (CONTINUED ON NEXT PAGE) 2. Lumbar Spine a. Period Prior to November 8, 2012 An August 2003 VA evaluation states that the Veteran complained of chronic low back pain. He reported that he was able to work at the USPS without exacerbating his symptoms. On examination of the lumbar spine, the Veteran exhibited a "good range of motion." An assessment of low back pain without focal neural deficit was advanced. At the July 2004 VA examination for compensation purposes, the Veteran complained of progressively worsening lumbar spine radiating pain which was exacerbated by increased activity; using the stairs; and lifting objects heavier than five pounds. He reported that he used a back brace; occasionally needed assistance from his wife to both get out of bed and to dress in the morning; and took approximately two days off from work a month due to his low back pain. He denied experiencing any bowel or bladder impairment. On examination of the lumbar spine, the Veteran exhibited a range of motion of forward flexion to 90 degrees with pain between 50 and 80 degrees, extension to 30 degrees, bilateral lateral flexion to 30 degrees, right lateral rotation to 45 degrees, and left lateral rotation to 40 degrees. The examiner commented that there was "no functional impairment due to this veteran's low back condition." The Veteran was diagnosed with "very mild" lumbosacral spine degenerative disc disease with no evidence of radiculopathy. At a March 2005 VA examination for compensation purposes, the Veteran complained of chronic low back pain which radiated down both his legs and was exacerbated by bending, stooping, and lifting heavy objects. On examination of the lumbosacral spine, the Veteran exhibited a range of motion of forward flexion to 90 degrees, extension to 30 degrees, bilateral lateral flexion to 30 degrees, and bilateral lateral rotation to 30 degrees without pain or fatigue. The examiner commented that the Veteran would have "no limitation of function of the lumbosacral spine due to pain." At the April 2006 VA examination for compensation purposes, the Veteran complained of recurrent radiating low back pain and stiffness which was exacerbated by exertion. He reported that he used a back brace and his USPS employment was limited by his inability to lift and to perform certain movements. On examination of the lumbar spine, the Veteran exhibited a range of motion of forward flexion to 65 degrees with pain from 10 to 55 degrees, extension to 25 degrees, bilateral lateral flexion to 30 degrees, and bilateral lateral rotation to 30 degrees; and no muscle spasm, paraspinous muscle tenderness, or spinal curvature abnormalities. The Veteran was diagnosed with "chronic low back strain secondary to annular tears, L3-4 and L4-5 with shallow disk protrusion" with no evidence of radiculopathy. The examiner commented that "there is mild functional impairment secondary to this veteran's lower back condition during acute flare ups." At the September 2006 DRO hearing, the Veteran testified that his lumbar spine disability impaired his ability to walk and to lift objects and prevented him from running. He stated that he used a back brace and had lost approximately 30 days from work in the preceding 12 months due to his low back pain. A June 2007 physical evaluation from the William Beaumont Army Medical Center notes that the Veteran complained of radiating low back pain. On examination of the thoracolumbar spine, the Veteran exhibited a range of motion of flexion to 65 degrees, extension to 25 degrees, right lateral flexion to 25 degrees, left lateral flexion to 30 degrees, and bilateral lateral rotation to 25 degrees with pain and muscle spasm. The Veteran was diagnosed with lumbar spine intervertebral disc degeneration and bilateral lower extremity polyneuropathy. The June 2008 written statement from the USPS conveys that the Veteran's service-connected disabilities were manifested by considerable impairment of his ability to perform his vehicle maintenance duties due to pain associated with bending. The undated FERS Agency Certification of Reassignment and Accommodation Efforts received in May 2009 states that the severity of the Veteran's medical conditions prevented him from continuing with his Federal Government employment. At the October 2009 VA examination for compensation purposes, the Veteran complained of severe chronic low back radiating pain which was exacerbated by lifting, standing, and prolonged sitting; weakness; stiffness; and numbness. He reported that he used a cane and a back brace; was unable to walk distances of more than "a few yards;" and had been medically retired due to his lumbar spine disability. On examination of the lumbar spine, the Veteran exhibited a range of motion of flexion to 60 degrees, extension to 20 degrees, bilateral lateral flexion to 20 degrees, and bilateral lateral rotation to 20 degrees; pain with all motions; kyphosis; and lumbar flattening. The Veteran was diagnosed with lumbar spine intervertebral disc syndrome. The examiner noted that the Veteran had been medically retired due to his lumbar spine and neuropathy disabilities. At the April 2011 videoconference before the undersigned Veterans Law Judge, the Veteran testified that his lumbar spine disability was manifested by chronic pain; had increased in severity; necessitated his medical retirement; and kept him at home. He acknowledged that he had not been prescribed bedrest by his physicians. The Veteran stated that his spouse had to help him to dress due to his lumbar spine pain. Prior to November 8, 2012, the weight of the evidence shows that the Veteran's service-connected lumbar spine degenerative joint disease to be manifested by no more than functional limitation of motion due to pain of forward flexion to 10 degrees, extension to 20 degrees, bilateral lateral flexion to 20 degrees, and bilateral lateral rotation to 20 degrees; kyphosis; lumbar flattening; and significant occupational impairment. Such functional impairment merits assignment of a 40 percent evaluation under Diagnostic Codes 5003, 5242. Separate evaluations for right lower extremity sciatic neuropathy and left lower extremity radiculopathy associated with the Veteran's lumbar degenerative joint disease have been previously assigned. The evaluation of the Veteran's right lower extremity sciatic neuropathy is the subject of the Remand portion of this decision below. During the relevant time period, the Veteran's lumbar spine disability was productive of significant occupational impairment which, in part, necessitated his medical retirement from the USPS. However, the weight of the evidence does not demonstrate unfavorable ankylosis of the entire thoracolumbar spine. The Veteran's functional loss due to pain has been considered in determining the assignment of the 40 percent rating. The Board finds that a 40 percent evaluation and no higher is warranted for the Veteran's lumbar spine degenerative joint disease for the period prior to November 8, 2012. 38 C.F.R. §§ 4.10, 4.40, 4.45, 4.71a, Diagnostic Codes 5003, 5242 (2012). b. Period on and after to November 8, 2012 At the November 2012 VA examination for compensation purposes, the Veteran complained of chronic radiating low back pain. He reported that he used a back brace and a cane and occasionally employed a walker. On examination of the lumbar spine, the Veteran exhibited a range of motion of forward flexion to 45 degrees with pain at 10 degrees, extension to 10 degrees with pain, bilateral lateral flexion to 15 degrees with pain, and bilateral lateral rotation to 20 degrees with pain; tenderness; guarding or muscle spasm; an abnormal gait; and abnormal spinal contour. The examiner stated that the Veteran had incapacitating episodes of less than one week over the preceding 12 months. The Veteran was diagnosed with lumbar spine degenerative disc disease with bilateral radiculopathy. The weight of the evidence shows that on and after November 8, 2012, the Veteran's lumbar spine degenerative joint disease has been manifested by no more than chronic radiating low back pain; functional limitation of motion due to pain of forward flexion to 10 degrees, extension to 10 degrees, bilateral lateral flexion to 15 degrees, bilaterally, and bilateral lateral rotation to 20 degrees; tenderness; guarding or muscle spasm; an abnormal gait; abnormal spinal contour; and significant occupational impairment. The Veteran's lumbar spine disability is productive of significant occupational impairment which, in part, necessitated his medical retirement from the USPS. Even with consideration of the functional limitation of motion due to pain, the weight of the evidence does not demonstrate unfavorable ankylosis of the entire thoracolumbar spine. The Board finds that a 40 percent evaluation and no higher is warranted for the Veteran's lumbar spine degenerative joint disease for the period on and after November 8, 2012. 38 C.F.R. §§ 4.10, 4.40, 4.45, 4.71a, Diagnostic Codes 5003, 5242 (2012). 3. Extraschedular Consideration The Board has also evaluated whether the Veteran's claims should be referred for consideration of an extra-schedular rating for cervical spine degenerative disc disease and lumbar spine degenerative joint disease under 38 C.F.R. § 3.321(b)(1). The Court has clarified that there is a three-step inquiry for determining whether a veteran is entitled to an extra-schedular rating. Initially, the Board must determine whether the evidence presents such an exceptional disability picture that the available schedular ratings for the service-connected disability are inadequate. Second, if the schedular rating does not contemplate an appellant's level of disability and symptomatology and is found inadequate, the Board must determine whether the appellant's disability picture exhibits other related factors such as those provided by the regulation as "governing norms." Third, if the rating schedule is inadequate to evaluate a appellant's disability picture and that picture has attendant thereto related factors such as marked interference with employment or frequent periods of hospitalization, then the case must be referred to the Under Secretary for Benefits or the Director of the Compensation and Pension Service to determine whether, to accord justice, the appellant's disability picture requires the assignment of an extraschedular rating. Thun v. Peake, 22 Vet App 111 (2008). With respect to the first prong of Thun, the evidence in this instant appeal does not establish such an exceptional disability picture as to render the schedular rating is inadequate. A comparison between the level of severity and symptomatology of the Veteran's spinal disabilities with the established criteria found in 38 C.F.R. § 4.71a, Diagnostic Codes 5003, 5242, and 5243 reflects that the diagnostic criteria reasonably describes the Veteran's disability level and symptomatology. The diagnostic criteria convey that evaluations will be assigned for spine disabilities based upon functional limitation of motion for both degenerative joint disease and degenerative disc disease and periods of incapacitation associated with degenerative disc disease. The Veteran's cervical spine and lumbar spine disability pictures have been shown to encompass significant functional limitation of motion which falls squarely within the diagnostic criteria for a 30 percent evaluation for his cervical spine degenerative disc disease and a 40 percent evaluation for his lumbar spine degenerative disc disease. The documentation of record does not show exceptional limitation due to the Veteran's spinal disabilities beyond that contemplated by the rating schedule. Therefore, the Board determines that referral of the claims for extra-schedular consideration pursuant to 38 C.F.R. § 3.321(b)(1) is not merited. III. Right Hip Bursitis The Veteran asserts that his right hip bursitis has increased in severity and is manifested by chronic joint pain and swelling. A. Historical Review The Veteran's service treatment records convey that he was seen for right hip complaints. The report of the February 1998 VA examination for compensation purposes states that the Veteran was diagnosed with chronic right hip trochanteric bursitis. In June 1998, the RO established service connection for right hip bursitis; assigned a 10 percent evaluation for that disability; and effectuated the award as of September 1, 1997. B. Increased Evaluation Bursitis is to be evaluated as degenerative arthritis on the basis of limitation of motion of the affected parts. 38 C.F.R. § 4.71a, Diagnostic Code 5019 (2012). Degenerative arthritis established by X-ray findings will be evaluated on the basis of limitation of motion of the specific joint or joints involved. When the limitation of motion of the specific joint or joints involved is noncompensable under the appropriate diagnostic codes, an evaluation of 10 percent is applied for each major joint or group of minor joints affected by the limitation of motion. 38 C.F.R. § 4.71a, Diagnostic Code 5003 (2012). Limitation of extension of the thigh to 5 degrees warrants a 10 percent evaluation. 38 C.F.R. § 4.71a, Diagnostic Code 5251 (2012). Limitation of flexion of the thigh to 45 degrees warrants a 10 percent evaluation. A 20 percent evaluation requires that flexion be limited to 30 degrees. A 30 percent evaluation requires that flexion be limited to 20 degrees. A 40 percent evaluation requires that flexion be limited to 10 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5252 (2012). A 10 percent evaluation is warranted where limitation of rotation of the thigh is such that it not possible to toe out more than 15 degrees. A 10 percent evaluation is also warranted where limitation of adduction of the thigh is such that one cannot cross the legs. A 20 percent evaluation is warranted where abduction is not possible beyond 10 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5253 (2012). The average normal range of motion of the hip is flexion from 0 to 125 degrees and abduction from 0 to 45 degrees. 38 C.F.R. § 4.71, Plate II (2012). A September 2003 VA treatment record states that the Veteran complained of right hip stiffness. At the July 2004 VA examination for compensation purposes, the Veteran complained of progressively worsening right hip pain which was exacerbated by using the stairs, sitting, and cold weather. He stated that he used a cane for walking long distances. The Veteran clarified that his right hip disability slowed his performance of both his occupational duties and his activities of daily living. On examination of the right hip, the Veteran exhibited a range of motion of flexion to 110 degrees with pain from 80 to 100 degrees, extension to 0 degrees, adduction to 20 degrees, and abduction to 40 degrees and tenderness along the region of the trochanter. The Veteran was diagnosed with trochanteric bursitis. The examiner commented that "there is mild functional impairment due to the Veteran's right hip condition during with flare ups only." At the April 2006 VA examination for compensation purposes, the Veteran complained of chronic right hip pain. He stated that his right hip disability "slowed him down" and became painful when he flexed his hip while working as a USPS maintenance worker. On examination of the right hip, the Veteran exhibited a range of motion of flexion to 120 degrees with pain, extension to 25 degrees, abduction to 25 degrees, abduction to 40 degrees, internal rotation to 25 degrees, and external rotation to 60 degrees. The Veteran was diagnosed with right hip bursitis. The examiner commented that "there is minimal functional impairment secondary to this veteran's right hip condition during acute flare ups." At the September 2006 DRO hearing, the Veteran testified that his right hip was painful and limited his ability to walk. At the October 2009 VA examination for compensation purposes, the Veteran complained of progressive right hip pain. He reported that he used a cane due to his right lower extremity symptoms and was unable to walk for more than a few yards. On examination of the right hip, the Veteran exhibited a range of motion of flexion to 55 degrees, extension to 0 degrees, and abduction to 25 degrees; the ability to cross his right leg over his left and to toes out greater than 15 degrees; and pain with motion. The Veteran was diagnosed with right hip bursitis. At the April 2011 videoconference hearing, the Veteran testified that he experienced chronic right hip pain and an associated limp. He stated that his right hip disability impaired his ability to do many activities. At the November 2012 VA examination for compensation purposes, the Veteran complained of right hip pain. He reported that he used a cane. On examination of the right hip, the Veteran exhibited a range of motion of flexion to 115 degrees with pain at 100 degrees and extension to a point "greater than 5" degrees with pain at 5 degrees; the ability to perform abduction beyond 10 degrees, to cross his right leg over his left and to toes out greater than 15 degrees; and pain with motion. The Veteran was diagnosed with right hip degenerative joint disease. The examiner commented that the Veteran's right hip disability slowed his ambulation and thus affected his performance of occupational tasks. The Veteran's right hip bursitis has been shown to be manifested by no more than chronic right hip pain; functional limitation of motion due to pain of flexion to 100 degrees and extension to "greater than 5" degrees with pain at 5 degrees; the ability to perform abduction beyond 10 degrees, to cross his right leg over his left and to toes out greater than 15 degrees; and pain with motion. Such limitation of extension to a point "greater than 5" warrants assignment of a 10 percent evaluation under Diagnostic Code 5251. The Veteran asserts that his right hip disability warrants assignment of an evaluation in excess of 10 percent as it is manifested by chronic pain and associated functional impairment. The weight of the evidence of record shows that the Veteran has not exhibited either actual or functional limitation of right thigh flexion to 30 degrees; limitation of rotation of the thigh where it is not possible to toe out more than 15 degrees; and/or limitation of adduction of the thigh where he could not cross his legs. In the absence of such impairment, the Board finds that a 10 percent evaluation under Diagnostic Code 5251 adequately reflects the Veteran's right hip disability picture at all relevant periods. Therefore, the Board concludes that an evaluation in excess of 10 percent is not warranted for the Veteran's right hip bursitis at any time during the pendency of this appeal. See Hart v. Mansfield, 21 Vet. App. 505 (2007). The Board has also evaluated whether the Veteran's claim should be referred for consideration of his entitlement to an extra-schedular evaluation for his service-connected right hip bursitis under 38 C.F.R. § 3.321(b)(1). With respect to the first prong of Thun, the evidence in this instant appeal does not establish such an exceptional disability picture as to render the schedular evaluation is inadequate. Evaluations for right hip bursitis are based upon functional limitation of motion of the hip. A comparison between the level of severity and symptomatology of the Veteran's right hip disorder with the established criteria found in 38 C.F.R. § 4.71a, Diagnostic Codes 5003, 5019, 5251, 5252, and 5253 reflects that the diagnostic criteria reasonably describes the Veteran's disability level and symptomatology. The documentation of record does not show exceptional limitation due to the Veteran's right hip disability beyond that contemplated by the rating schedule. Therefore, the Board has determined that referral of this case for extra-schedular consideration pursuant to 38 C.F.R. § 3.321(b)(1) is not warranted. Accordingly, an evaluation in excess of 10 percent for the Veteran's right hip bursitis is not warranted. IV. Left Ear Hearing Loss Disability The Veteran asserts that a compensable evaluation is warranted for his left ear hearing loss as the disability is productive of significant impairment which prevents him from understanding conversations. 1. Historical Review The Veteran's service treatment records convey that he exhibited left ear hearing loss during active service. The report of a February 1998 VA audiological examination for compensation purposes states that the Veteran exhibited pure tone thresholds, in decibels, as follows: HERTZ 500 1000 2000 3000 4000 LEFT 5 15 30 35 35 Speech audiometry revealed speech recognition ability of 96 percent in the left ear. In June 1998, the RO established service connection for left ear hearing loss; assigned a noncompensable evaluation for that disability; and effectuated the award as of September 1, 1997. 2. Increased Evaluation Disability evaluations for unilateral hearing loss disability range from noncompensable to 10 percent based on the degree of organic impairment of hearing acuity as measured by the results of controlled speech discrimination tests together with the average hearing threshold level as measured by a pure tone audiometry test in the frequencies of 1,000, 2,000, 3,000, and 4,000 cycles per second. The rating schedule establishes eleven auditory acuity levels designated from Level I for essentially normal auditory acuity to Level XI for profound deafness. The evaluations derived from the schedule are intended to make allowance for improvement by hearing aids. 38 C.F.R. § 4.85, Diagnostic Code 6100 (2012). Exceptional patterns of hearing impairment are to be evaluated in accordance with the provisions of 38 C.F.R. § 4.86 (2012). That regulation states that: (a) When the pure tone threshold at each of the four specified frequencies (1000, 2000, 3000, and 4000 Hertz) is 55 decibels or more, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIa, whichever results in the higher numeral. Each ear will be evaluated separately. (b) When the pure tone threshold is 30 decibels or less at 1000 Hertz, and 70 decibels or more at 2000 Hertz, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIa, whichever results in the higher numeral. That numeral will then be elevated to the next higher Roman numeral. Each ear will be evaluated separately. In evaluating hearing loss, disability evaluations on a schedular basis are derived by a mechanical application of the ratings schedule to the numeric designations assigned after audiometric evaluations are rendered. See Lendenmann v. Principi, 3 Vet. App. 345, 349 (1992). The Court has clarified that VA audiological evaluations should include both objective test results and a full description of the functional effect of the Veteran's hearing loss disability. Martinak v. Nicholson, 21 Vet. App. 447 (2007). At a June 2004 audiological examination for compensation purposes conducted for VA, the Veteran complained of difficulty understanding speech when background noise is present. On evaluation, the Veteran exhibited pure tone thresholds, in decibels, as follows: HERTZ 1000 2000 3000 4000 LEFT 20 30 40 35 Speech audiometry revealed speech recognition ability of 100 percent in the left ear. The Veteran was diagnosed with "mild high frequency sensorineural hearing loss with excellent speech discrimination." At an April 2006 audiological examination for compensation purposes conducted for VA, the Veteran complained of difficulty understanding speech when background noise is present. On evaluation, the Veteran exhibited pure tone thresholds, in decibels, as follows: HERTZ 1000 2000 3000 4000 LEFT 20 30 45 50 Speech audiometry revealed speech recognition ability of 84 percent in the left ear. The Veteran was diagnosed with mild to moderate high frequency sensorineural hearing loss with "normal speech discrimination." At the September 2006 hearing, the Veteran testified that he had been told that he needed hearing aids. At an October 2009 VA audiological examination for compensation purposes conducted for VA, the Veteran exhibited pure tone thresholds, in decibels, as follows: HERTZ 1000 2000 3000 4000 LEFT 20 40 50 50 Speech audiometry revealed speech recognition ability of 96 percent in the left ear. The Veteran was diagnosed with mild to moderate high frequency sensorineural hearing loss. The examiner noted that the Veteran was retired and concluded that there was no effects of the left ear hearing loss on his usual daily activities. At the April 2011 videoconference hearing, the Veteran testified that he could not understand conversations if there was any background noise. At a November 2011 VA audiological examination for compensation purposes conducted for VA, the Veteran exhibited pure tone thresholds, in decibels, as follows: HERTZ 1000 2000 3000 4000 LEFT 25 45 60 55 Speech audiometry revealed speech recognition ability of 96 percent in the left ear. The Veteran was diagnosed with mild to moderate high frequency sensorineural hearing loss. The examiner opined that the Veteran "would be expected to understand normal conversational-level speech quite well in quiet environments" and "would be expected to have mild to moderate residual difficulty with speech understanding" in environments with significant background noise. She determined further that the Veteran's left ear hearing loss did not preclude substantially gainful employment. The Veteran's left ear hearing loss disability has been objectively shown to be productive of no more than Level II auditory acuity. Examining audiologists have noted that the Veteran would have some difficulty with hearing conversations in a noisy environment. However, such impairment was not determined to be productive of significant occupational impairment. Such findings do not support assignment of a compensable evaluation. The Veteran does not exhibit an exceptional pattern of hearing impairment as to warrant application of 38 C.F.R. § 4.86 (2012). The Veteran's audiometric findings fall squarely within the criteria for a noncompensable evaluation under the provisions of 38 C.F.R. § 4.85, Diagnostic Code 6100. Therefore, the Board concludes that a compensable schedular evaluation is not warranted for the Veteran's left hearing loss at any time during the pendency of this appeal. See Hart v. Mansfield, 21 Vet. App. 505 (2007). The Board has also evaluated whether the Veteran's claim should be referred for consideration of his entitlement to an extra-schedular evaluation for his service-connected hearing loss disability under 38 C.F.R. § 3.321(b)(1). With respect to the first prong of Thun, the evidence in this instant appeal does not establish such an exceptional disability picture as to render the schedular evaluation is inadequate. Evaluations for hearing loss are assigned based upon audiometric testing. A comparison between the level of severity and symptomatology of the Veteran's left ear hearing loss with the established criteria found in 38 C.F.R. § 4.85, Diagnostic Code 6100 reflects that the diagnostic criteria reasonably describes the Veteran's disability level and symptomatology. The Veteran does not exhibit an exceptional pattern of hearing impairment as to warrant application of 38 C.F.R. § 4.86. His hearing loss has not been shown to be productive of significant occupational impairment. Therefore, the Board has determined that referral of this case for extra-schedular consideration pursuant to 38 C.F.R. § 3.321(b)(1) is not warranted. Accordingly, a compensable evaluation for the Veteran's left ear hearing loss is not warranted. (CONTINUED ON NEXT PAGE) ORDER A 30 percent evaluation for the Veteran's cervical spine degenerative disc disease is granted subject to the law and regulations governing the award of monetary benefits. A 40 percent evaluation for the Veteran's lumbar spine degenerative joint disease for the period prior to November 8, 2012, is granted subject to the law and regulations governing the award of monetary benefits. An evaluation in excess of 40 percent for the Veteran's lumbar spine degenerative joint disease for the period on and after November 8, 2012, is denied. An increased evaluation for the Veteran's right hip bursitis is denied. An increased evaluation for the Veteran's left ear hearing loss is denied. REMAND The Veteran asserts that an increased evaluation is warranted for his right lower extremity sciatic neuropathy. In reviewing the reports of the December 2011 and November 2012 VA examinations for compensation purposes, the Board observes that there is an apparent conflict as to the nature of the Veteran's service-connected right lower extremity neurological disability. While the December 2011 VA examination report conveys that the Veteran was found to have moderate incomplete paralysis of both the right sciatic and the right external (common) peroneal nerves, the November 2012 VA examination states that the Veteran was found to have moderate incomplete paralysis of the right sciatic nerve and a normal right external (common) peroneal nerve. VA's duty to assist includes, in appropriate cases, the duty to conduct a thorough and contemporaneous medical examination which is accurate and fully descriptive. McLendon v. Nicholson, 20 Vet. App. 79 (2006); Floyd v. Brown, 9 Vet. App. 88, 93 (1996); Ardison v. Brown, 6 Vet. App. 405, 407-08 (1994); Green v. Derwinski, 1 Vet. App. 121, 124 (1991). Given the apparently conflicting neurological findings, the Board concludes that further VA neurological evaluation would be helpful in resolving the issues raised by the instant appeal. Clinical documentation dated after November 2012 is not of record. VA should obtain all relevant VA and private clinical documentation which could potentially be helpful in resolving the Veteran's claims. Murphy v. Derwinski, 1 Vet. App. 78, 81-82 (1990); Bell v. Derwinski, 2 Vet. App. 611 (1992). The Court has directed that when entitlement to a TDIU is raised during the adjudicatory process of evaluating the underlying disability, it is part of the claim for benefits for the underlying disability. Rice v. Shinseki, 22 Vet. App. 447, 454 (2009). Entitlement to a TDIU requires an accurate assessment of the functional impairment associated with all of the Veteran's service-connected disabilities. In light of increased evaluations for the Veteran's cervical spine and lumbar spine disabilities above, the Board remands the issue of entitlement to a TDIU for the period prior to December 8, 2011 to the RO for reevaluation. Accordingly, the case is REMANDED for the following action: 1. Contact the Veteran and request that he provide information as to all treatment of his service-connected right lower extremity neurological disability after November 2012, including the names and addresses of all health care providers whose records have not already been provided to VA. Upon receipt of the requested information and the appropriate releases, the RO should contact all identified health care providers and request that they forward copies of all available clinical documentation pertaining to treatment of the Veteran, not already of record, for incorporation into the record. If the identified documentation is not ultimately obtained, the Veteran should be notified pursuant to 38 C.F.R. § 3.159(e) (2012). 2. Associate with the record any VA clinical documentation pertaining to the treatment of the Veteran not already of record, including that provided after November 2012. 3. Then schedule the Veteran for a VA neurological examination for compensation purposes in order to assist in determining the current nature and severity of his service-connected right lower extremity sciatic neuropathy. All indicated tests and studies should be accomplished and the findings then reported in detail. The examiner should specifically identify the specific right lower extremity nerves affected by the Veteran's service-connected sciatic neuropathy. The VA examiner should identify the limitation of activity imposed by the Veteran's right lower extremity sciatic neuropathy with a full description of the effect of the disabilities upon his ordinary activities. The examiner should fully describe any pain, stiffness, weakened movement, excess fatigability, and incoordination that are present. Determinations on whether the Veteran exhibits pain with use of his right lower extremity should be noted and described. If feasible, the determinations concerning pain, weakness, and fatigability should be portrayed in terms of the degree of additional range of motion loss. If such a determination is not feasible, this should be stated for the record and the reasons provided. The examiner should express an opinion as to the impact of the Veteran's right lower extremity neurological disability upon his vocational pursuits. All relevant medical records, including those in the claims folders, should be made available to the examiner for review of pertinent documents therein. The examination report should specifically state that such a review was conducted. A rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. However, if the requested opinion cannot be provided without resort to speculation, the examiner should so state and explain why an opinion cannot be provided without resort to speculation. 4. Thereafter, ensure that the development above has been completed in accordance with the remand instructions and undertake any other development action that is deemed warranted. Then readjudicate the remaining issues of the evaluation of the Veteran's right lower extremity sciatic neuropathy and entitlement to a TDIU for the period prior to December 8, 2011. If the benefits sought on appeal remain denied, the Veteran should be provided a supplemental statement of the case (SSOC). An appropriate period of time should be allowed for response before the case is returned to the Board. The Veteran has the right to submit additional evidence and argument on the matter the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). These claims must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board or by the Court for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. § 5109B, 7112 (West 2002). ____________________________________________ K. J. ALIBRANDO Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs