Citation Nr: 18143360 Decision Date: 10/19/18 Archive Date: 10/18/18 DOCKET NO. 15-44 811 DATE: October 19, 2018 ORDER Entitlement to service connection for tinnitus is denied. Entitlement to service connection for headaches is denied. Entitlement to a rating in excess of 10 percent for a low back disability prior to August 8, 2017 and a rating in excess of 40 percent thereafter is denied. Entitlement to an initial rating in excess of 10 percent for radiculopathy of the left lower extremity from October 24, 2014 to May 18, 2016 is denied. Entitlement to a rating of 40 percent, but no higher, for radiculopathy of the left lower extremity from May 18, 2016 is warranted. Entitlement to a separate rating of 10 percent, but no higher, for radiculopathy of the right lower extremity is granted, effective from August 8, 2017. Entitlement to an initial compensable rating for left ear hearing loss is denied. REMANDED Entitlement to service connection for a neck disorder is remanded. Entitlement to service connection for a right hip disorder, to include as secondary to the service connected low back disability is remanded. Entitlement to service connection for a left hip disorder, to include as secondary to the service connected low back disability is remanded. Entitlement to service connection for a right shoulder disorder is remanded. Entitlement to service connection for a left knee disorder is remanded. Entitlement to service connection for sleep apnea, to include as due to the service connected low back disability is remanded. Entitlement to a 10 percent evaluation for multiple noncompensable service-connected disabilities pursuant to 38 C.F.R. § 3.324 is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that the Veteran has tinnitus due to a disease or injury in service. 2. The preponderance of the evidence is against finding that the Veteran has a current diagnosis of headaches at any point during the appeal period. 3. For the period from October 24, 2014 to August 8, 2017, the Veteran’s lumbar spine was manifested by flexion limited to, at most, 80 degrees. There is no evidence of incapacitating episodes, ankylosis, or bowel or bladder impairment. 4. From August 8, 2017, the Veteran’s lumbar spine is manifested by pain with flexion limited to 10 degrees, without evidence of incapacitating episodes during the past 12 months. There is no evidence of bowel or bladder impairment, or ankylosis. 5. For the period from October 24, 2014 to May 18, 2016, the competent and credible evidence shows the Veteran’s radiculopathy of the left lower extremity is manifested by mild incomplete paralysis of the sciatic nerve. 6. From May 18, 2016, the competent and credible evidence shows the Veteran’s radiculopathy of the left lower extremity is manifested by moderately severe incomplete paralysis of the sciatic nerve. 7. Effective from August 8, 2017, the competent and credible evidence suggests that the Veteran suffers from radiculopathy of the right lower extremity, which is manifested by mild incomplete paralysis of the sciatic nerve. 8. Service connection for hearing loss is in effect for the left ear only. 9. The Veteran has demonstrated no worse than Level III hearing in the left ear. CONCLUSIONS OF LAW 1. The criteria for service connection for tinnitus have not been met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.309. 2. The criteria for service connection for headaches have not been met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 3. For the period from October 24, 2014 to August 8, 2017, the criteria are not met for a rating in excess of 10 percent for the lumbar spine disability. 38 U.S.C. § 1155 (West 2012); 38 C.F.R. §§ 4.1, 4.7, 4.40, 4.45, 4.59, 4.71a, 4.124a, Diagnostic Code 5243 (2017). 4. From August 8, 2017, the criteria are not met for a rating in excess of 40 percent for the lumbar spine disability. 38 U.S.C. § 1155 (West 2012); 38 C.F.R. §§ 4.1, 4.7, 4.40, 4.45, 4.59, 4.71a, 4.124a, Diagnostic Code 5243 (2017). 5. For the period from October 24, 2017 to May 18, 2016, the criteria are not met for a rating in excess of 10 percent for radiculopathy of the left lower extremity. 38 U.S.C. §§ 1155, 5107 (West 2012); 38 C.F.R. §§ 4.1-4.14, 4.124a, Diagnostic Code 8520 (2017). 6. From May 18, 2016, the criteria are met for a rating of 40 percent, but no higher, for radiculopathy of the left lower extremity. 38 U.S.C. §§ 1155, 5107 (West 2012); 38 C.F.R. §§ 4.1-4.14, 4.124a, Diagnostic Code 8520 (2017). 7. Effective from August 8, 2017, the criteria have been met for a separate 10 percent disability rating, and not higher, for radiculopathy of the right lower extremity. 38 U.S.C. §§ 1155, 5107 (West 2012); 38 C.F.R. §§ 4.1-4.14, 4.124a, Diagnostic Code 8520 (2017). 8. The criteria for a compensable rating for the Veteran’s left ear hearing loss have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (West 2012); 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.10, 4.85, 4.86, Diagnostic Code 6100 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 1980 to September 1984. Service Connection To prevail on a direct service connection claim, there must be competent evidence of (1) a current disability, (2) in-service incurrence or aggravation of a disease or injury, and (3) a nexus between the in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009); 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303 (a). 1. Entitlement to service connection for tinnitus. The Veteran is seeking entitlement to service connection for tinnitus that he believes is due to his military service. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has a diagnosis of tinnitus, the preponderance of the evidence is against finding that it began during active service, or is otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). The Veteran’s service treatment records are completely silent regarding any complaints, treatment, or a diagnosis of tinnitus, or even symptoms commonly associated with tinnitus. Additionally, his personnel record shows the Veteran’s military occupational specialty was listed as wheel vehicle repairer. See DD Form 214. Following service, the available VA treatment records fail to show any treatment for or complaints of tinnitus. In November 2014, the Veteran was scheduled for a VA examination regarding this claim for service connection. The VA examiner stated that the Veteran’s service treatment records and VA treatment records do not report any complaints of tinnitus or its symptoms. The examiner also noted that the Veteran denied any noise exposure after 1984 and stated tinnitus first began in 2011. Therefore, the examiner concluded that it is less likely as not that the currently diagnosed tinnitus is due to the Veteran’s military service. Based on the foregoing, the Board concludes that the evidence is against the service connection claim. The November 2014 VA examiner found the Veteran’s tinnitus was not related to service. This examiner conducted a comprehensive clinical examination and evidentiary review, and indicated familiarity with the Veteran’s pertinent medical and lay history. The examiner provided a rationale regarding the Veteran’s current condition and offered an adverse opinion regarding the relationship between the Veteran’s active duty service and the results of the examination. There are no conflicting opinions. The Veteran has asserted his personal belief that his diagnosed tinnitus is due to noise exposure in service. The Veteran is competent to report noise exposure in service and to report ringing in his ears, but he is not competent to opine regarding the etiology of his tinnitus that demonstrably became manifest many years after service, especially where there has been no continuity of symptomatology. Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Notably, the Board has considered continuity of symptomatology, especially where the Court has clarified that the Federal Circuit’s decision in Walker does not preclude establishing service connection for tinnitus on the basis of continuity of symptoms, because tinnitus is an “organic disease of the nervous system,” which is listed in § 3.309(a). Fountain v. McDonald, 27 Vet. App. 258, 272 (2015); see Walker v. Shinseki, 708 F.3d 1331, 1340 (Fed. Cir. 2013). However, here, as stated previously, after service the available VA treatment records did not show any treatment for or complaints of tinnitus. In fact, the Veteran himself reported that tinnitus began in 2011, approximately 27 years after his separation from service. Given that this was information given by the Veteran, the Board finds this evidence highly probative. As such, there has been no evidence of a chronic disease in service or continuity of symptomatology. In sum, the Veteran’s claim fails to meet the second and third prongs of service connection, which is the requirement of an in-service incurrence and a nexus to service. As the preponderance of the evidence is against the Veteran’s claim of entitlement to service connection, the benefit-of-the-doubt doctrine is not for application. 38 U.S.C. § 5107(b). As such, the claim must be denied. 2. Entitlement to service connection for headaches. The Veteran is seeking entitlement to service connection for headaches that he believes is due to his military service. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that the Veteran does not have a current diagnosis of headaches and has not had one at any time during the pendency of the claim or recent to the filing of the claim. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007); 38 C.F.R. § 3.303(a), (d). The Veteran’s service treatment records are completely silent for any complaints, treatment, or a diagnosis of headaches. Post-service VA and private treatment records dating through 2018 note only one instance of a complaint regarding headaches in August 2005. At that time, the treating physician noted the Veteran’s report that his headaches started one year or more ago. There are no additional indications that the Veteran has sought treatment for additional headaches since the isolated instance in 2005. The only evidence in support of the Veteran’s claim are his lay assertions that he currently suffers from headaches. While the Veteran may, in fact, experience headaches, the fact remains that the objective medical evidence does not show that he sought medical treatment for those headaches at any point during the appeals period; or, that he asserts continuity of symptoms since service. Consequently, the Board gives more probative weight to the competent medical evidence as well as the Veteran’s own assertions that his headaches began in approximately 2004. The Board must deny service connection because there is no evidence the Veteran currently has a headache disorder. Brammer v. Derwinski, 3 Vet. App. 223 (1995) (Congress specifically limited entitlement for service-connected disease or injury to cases where such incidents had resulted in a disability); see also McClain v. Nicholson, 21 Vet. App. 319 (2007) (the requirement that a current disability be present is satisfied “when a claimant has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim... even though the disability resolves prior to the Secretary’s adjudication of the claim.”). Further, assuming arguendo, that the Veteran has current chronic headaches, there is no evidence to support a finding that any current headaches had their onset during service or are otherwise related to any in-service disease or injury. As the preponderance of the evidence is against the Veteran’s claim of entitlement to service connection, the benefit-of-the-doubt doctrine is not for application. 38 U.S.C. § 5107(b). As such, the claim must be denied. Increased Rating Disability ratings are determined by applying the criteria set forth in VA’s Schedule for Rating Disabilities. The percentage ratings are based on the average impairment of earning capacity and individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155 (2012); 38 C.F.R. § 4.1 (2017). The Veteran’s entire history is to be considered when making disability evaluations. See generally 38 C.F.R. § 4.1 (2017); Schafrath v. Derwinski, 1 Vet. App. 589 (1995). Staged ratings are appropriate for any rating claim when the factual findings show distinct time periods during the appeal period where the service-connected disability exhibits symptoms that would warrant different ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007). Staged ratings are appropriate for any initial rating claim when the factual findings show distinct time periods during the appeal period where the service-connected disability exhibits symptoms that would warrant different ratings. Fenderson v. West, 12 Vet. App. 119, 126 (1999). Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7 (2017). Any reasonable doubt regarding a degree of disability will be resolved in favor of the veteran. 38 C.F.R. § 4.3 (2017). 3. Entitlement to a rating in excess of 10 percent for a low back disability for the period from October 24, 2014 to August 8, 2017 and a rating in excess of 40 percent thereafter. The Veteran is seeking a rating in excess of 10 percent for a low back disability prior to August 8, 2017 and a rating in excess of 40 percent thereafter, pursuant to the provisions of Diagnostic Code 5243, 38 C.F.R. § 4.71a. As an initial matter, the Veteran filed his claim of entitlement to an increased rating on October 24, 2014. Therefore, the relevant temporal focus for this appeal is from October 24, 2013, one year prior to the date of receipt of the claim. 38 C.F.R. § 3.400. Disability of the musculoskeletal system is primarily the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination and endurance. Functional loss may be due to the absence or deformity of structures or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by the visible behavior in undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. § 4.40. In determining the appropriate evaluation for musculoskeletal disabilities, particular attention is focused on functional loss of use of the affected part. Under 38 C.F.R. § 4.40, functional loss may be due to pain, supported by adequate pathology and evidenced by visible behavior on motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. Under 38 C.F.R. § 4.45, factors of joint disability include increased or limited motion, weakness, fatigability, or painful movement, swelling, deformity or disuse atrophy. Under 38 C.F.R. § 4.59, painful motion is an important factor of joint disability and actually painful joints are entitled to at least the minimum compensable rating for the joint. This regulation also requires that, whenever possible, the joints involved are tested for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with the range of the opposite undamaged joint. See Correia v. McDonald, 28 Vet. App. 158, 168 (2016). Where functional loss is alleged due to pain upon motion, the provisions of 38 C.F.R. § 4.40 and § 4.45 must be considered. DeLuca v. Brown, 8 Vet. App. 202, 207-08 (1995). Within this context, a finding of functional loss due to pain must be supported by adequate pathology, and evidenced by the visible behavior of the claimant. Johnston v. Brown, 10 Vet. App. 80, 85 (1997). Pain itself does not rise to the level of functional loss as contemplated by § 4.40 and § 4.45, but may result in functional loss only if it limits the ability to perform the normal working movements of the body with normal excursion, strength, coordination or endurance. Mitchell v. Shinseki, 25 Vet. App. 32, 43 (2011). A recent United States Court of Appeals for Veterans Claims (Court) decision addressed what constitutes an adequate explanation for an examiner’s inability to estimate motion loss in terms of degrees during periods of flare-ups. Sharp v. Shulkin, 29 Vet. App. 26 (2017). In Sharp, the Court held that a VA examiner must attempt to elicit information from the record and the Veteran regarding the severity, frequency, duration, or functional loss manifestations during flare-ups before determining that an estimate of motion loss in terms of degrees could not be given. It also held that any inability to furnish such an estimate must be predicated on a lack of medical knowledge among the medical community at large, rather than insufficient knowledge by the individual examiner. Id. The Veteran’s lumbar spine disability has been rated under Diagnostic Code 5243. Diagnostic Code 5243 directs VA to rate the Veteran under either the General Rating Formula for Diseases and Injuries of the Spine or the Formula for Rating Intervertebral Disc Syndrome (IVDS) Based on Incapacitating Episodes. 38 C.F.R. § 4.71a, Diagnostic Codes 5237-5243 (2017). Under Diagnostic Code 5243, this disability is rated according to the number of incapacitating episodes a person has had in the past 12 months. 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. See Note (1) to Diagnostic Code 5243. Under the formula, a 10 percent rating is assigned for incapacitating episodes having a total duration of at least one week but less than 2 weeks during the past 12 month period, a 20 percent rating is assigned for incapacitating episodes having a total duration between 2 to 4 weeks during the past 12 month period, a 40 percent rating is assigned for incapacitating episodes having a total duration between 4 to 6 weeks during the past 12 month period, and a 60 percent rating is assigned for incapacitating episodes having a total duration of at least 6 weeks during the past 12 months. 38 C.F.R. § 4.71a, Diagnostic Code 5243, Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes. Note (1) to Diagnostic Code 5243 provides that, for purposes of ratings under Diagnostic Code 5243, an incapacitating episode is a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician. Otherwise, under 38 C.F.R. § 4.71a, Diagnostic Codes 5235 to 5243, spine disorders are to be rated under the General Rating Formula for Diseases and Injuries of the Spine on the basis of limitation of motion. Under these diagnostic codes, a 10 percent rating is assigned when rating forward flexion of the thoracolumbar spine is 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 assigned when forward flexion of the thoracolumbar spine is greater than 30 degrees, but not greater than 60 degrees; when the combined range of motion of the thoracolumbar spine is not greater than 120 degrees; or when there is 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 when forward flexion of the thoracolumbar spine is 30 degrees or less, or there is favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is assigned when there is unfavorable ankylosis of the thoracolumbar spine only. Finally, a 100 percent rating is assigned when there is unfavorable ankylosis of the entire spine. As described above, the higher rating for 50 percent requires unfavorable ankylosis of the entire thoracolumbar spine. 38 C.F.R. § 4.71, Diagnostic Code 5242. The Court, citing Dorland’s Illustrated Medical Dictionary (28th ed. 1994), has recognized that ankylosis is defined as “immobility and consolidation of a joint due to disease, injury or surgical procedure,” for VA compensation purposes. See Colayong v. West, 12 Vet. App. 524, 528 (1999); Shipwash v. Brown, 8 Vet. App. 218, 221 (1995). The General Rating Formula for Diseases and Injuries of the Spine, provide further guidance in rating diseases or injuries of the spine. In pertinent part, Note (1) provides that any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, should be rated separately under an appropriate diagnostic code. Note (2) provides that, for VA compensation purposes, 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 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. The normal combined range of motion of the thoracolumbar spine is 240 degrees. The normal ranges of motion for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion. See also Plate V, 38 C.F.R. § 4.71a. For the Period From October 24, 2014 to August 8, 2017 For the period from October 24, 2014 to August 8, 2017, the evidence of record includes a VA examination dated in December 2014, a private examination dated in May 2016, and VA and private treatment records. In the December 2014 VA examination, conducted in connection with his claim for an increased rating, the examiner noted the Veteran’s report of flare-ups. The functional impact of the flare-ups includes chronic pain at the beltline without radiation, which limits activity. Range of motion testing revealed flexion to 80 degrees, extension to 20 degrees, right and left lateral flexion to 30 degrees, and right and left lateral rotation to 30 degrees. The Veteran was able to perform repetitive use testing resulting in the same range of motion findings. While there was no additional limitation in range of motion following repetitive testing, the examiner did note an additional functional impact on the Veteran in terms of less movement than normal. Additionally, there was no evidence of localized tenderness or pain on palpation, guarding or spasms, or muscle atrophy. Muscle strength testing, deep tendon reflexes, and sensory examination were all normal. Straight leg raising was negative bilaterally. The examiner did not find evidence of any neurological impairments, including radiculopathy and bowel or bladder impairments. Finally, the Veteran does not require the use of an assistive device and there is no evidence of ankylosis or IVDS. Regarding any limitation in functional ability concerning pain, incoordination, weakness, or fatiguability, the examiner stated there is no way of adding information regarding the decrease in range of motion, if any occurs, during the Veteran’s reported flare-up. The examiner stated the rationale is because either the Veteran is having a flare-up when the examiner is present and the decrease does not show any objective evidence of painful motion. Alternatively, if the examiner is not present, then any decrease would be a guess from the Veteran which would be inaccurate and a self-serving, non-objective statement. In support of his claim for an increased rating, the Veteran submitted a private medical opinion dated in May 2016. At that time, private physician noted the Veteran’s report that his back pain is constant. He reports that he cannot sit for more than 10 minutes or stand for more than 5 minutes without his back pain increasing. Additionally, the Veteran reported he generally uses a cane. Objective range of motion findings were not included in this May 2016 medical opinion. Additionally, the Veteran’s VA and private treatment records show his continuous complaints of pain associated with his low back disability. However, the objective range of motion findings in these treatment records are not materially different from the objective findings noted in the December 2014 VA examination. For the first period on appeal , the Board concludes that the preponderance of the evidence is against the Veteran’s claim for a disability rating in excess of 10 percent for his service-connected low back disability. In particular, the Board acknowledges the Veteran’s complaints of back pain, which the record clearly documents. However, the Veteran’s flexion was limited, at most, to 80 degrees, even when considering any reported pain during his December 2014 and May 2016 VA and private examinations, respectively. Additionally, while the Veteran reported flare-ups in December 2014, he only indicated that it was in the form of pain at the beltline. With respect to functional loss, the December 2014 VA examination noted evidence of less motion than normal, but no additional limitations due to pain, repetitive motion, or functional loss. Specifically, the examiner noted that no response was provided by the Veteran regarding when pain began during range of motion testing. Regardless, the evidence shows that the Veteran’s range of motion for flexion was well in excess of 60 degrees, which is required for the next higher 20 percent rating for the entire period on appeal. Therefore, the Board finds that even when considering the functional limitations of less movement than normal as identified in 38 C.F.R. §§ 4.40, 4.45 4.59 as well as the criteria in DeLuca and Mitchell, the Veteran’s functional loss did not equate to the criteria required for a 20 percent rating when considering the cumulative picture of his low back disability for the first period on appeal. Further, to the extent the December 2014 VA examination did not comply with the holdings in Correia or Sharp, either individually or collectively, such non-compliance is harmless error. In this respect, while the Veteran reported flare-ups, the examiner addressed the fact that he was unable to provide range of motion findings. Additionally, there was no evidence of pain during range of motion findings, to include pain on weight-bearing. As for whether the Veteran is entitled to a rating in excess of 10 percent rating for IVDS, the December 2014 VA examination does not include any evidence of IVDS. There is no other medical evidence, aside from what has been discussed in detail above, which would support the Veteran’s contentions that his lumbar spine disability has increased in severity beyond the currently assigned 10 percent rating for this first period on appeal. For the Period Since August 8, 2017 For the period since August 8, 2017, the Veteran is currently rated at 40 percent. The objective evidence of record for this period includes the report of the August 2017 VA examination and the available VA and private treatment records. As mentioned, the next higher rating for 50 percent requires unfavorable ankylosis of the entire thoracolumbar spine. 38 C.F.R. § 4.71, Diagnostic Code 5243. Alternatively, the next higher rating for IVDS of 60 percent requires incapacitating episodes having a total duration of at least 6 weeks in the past 12 months. Id. During the August 2017 VA examination, the Veteran reported the existence of flare-ups, with reported functional impairment as weakness and pain with limited range of movement of the back and legs. Range of motion testing revealed 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. All movement resulted in pain and the examiner noted there was evidence of pain on weight-bearing resulting in tender lower lumbar spine. Additionally, the Veteran was unable to perform repetitive testing due to pain. Further, all additional range of motion testing revealed the same degree of movement in the Veteran’s lumbar spine, but the examiner did also note that pain, fatigue, weakness, and lack of endurance significantly limited functional ability. There was also evidence of guarding and muscle spasm resulting in abnormal gait or abnormal spinal contour. As for neurological manifestations, the examiner noted the presence of moderate radiculopathy of the left lower extremity and mild radiculopathy of the right lower extremity, but there was no evidence of other neurological manifestations, such as bowel or bladder impairment. The examiner also indicated the Veteran has IVDS but noted that he has not suffered from incapacitating episodes during the last 12 months. There was no indication of ankylosis. The examiner finally noted that the Veteran required the use of a cane. Additionally, for the period on appeal since August 8, 2017, there are a significant number of VA and private treatment records. Unfortunately, these treatment records do not contain any evidence that the Veteran suffers from ankylosis or that he has had at least 6 weeks of incapacitating episodes within a 12-month period to warrant the higher 50 and 60 percent ratings, respectively. Therefore, even considering any additional functional impact of the Veteran’s lumbar spine as noted above and his reports of pain, the fact remains the Veteran retains motion in his lumbar spine, albeit limited, which precludes a finding of ankylosis. The Board finds that even when considering functional limitations due to pain and the other factors identified in 38 C.F.R. §§ 4.40, 4.45 4.59 as well as the criteria in DeLuca and Mitchell, the Veteran’s functional loss did not equate to the criteria required for a 50 percent rating. Further, to the extent the August 2017 VA examination failed to comply with the holdings in Correia or Sharp, either individually or collectively, such non-compliance is harmless error. In this respect, the Court in Johnston, supra, indicated that where the Veteran is in receipt of the maximum schedular evaluation based on limitation of motion and a higher rating requires ankylosis, the cited regulations are not for application. Johnston, 10 Vet. App. at 84-85 (although the Secretary suggested remand because of the Board’s failure to consider functional loss due to pain, remand was not appropriate because higher schedular rating required ankylosis). Thus, as the Veteran is in receipt of the maximum schedular rating based on limitation of motion and a higher rating requires ankylosis of other symptoms unrelated to limitation of motion, 38 C.F.R. § 4.40 and 4.45 are not for application. As for whether the Veteran is entitled to the higher 60 percent rating, which requires incapacitating episodes having a total duration of at least 6 weeks during the past 12 months, pursuant to 38 C.F.R. § 4.71a, Diagnostic Code 5243, the August 2017 VA examiner determined the Veteran has IVDS but has not suffered from any incapacitating episodes. Thus, he is not entitled to the higher 60 percent rating based on incapacitating episodes. There is no additional medical evidence, as discussed in detail above, which would support the Veteran’s contentions that his lumbar spine disability has increased in severity beyond the currently assigned 40-percent rating. In addition to considering the orthopedic manifestations of a lumbar spine disability, VA regulations also require that consideration be given to any associated objective neurologic abnormalities, which are to be evaluated separately under an appropriate diagnostic code. Here, the evidence supports a finding for a separate rating for radiculopathy of the right lower extremity. However, as the Veteran is also service connected for radiculopathy of the left lower extremity, which is currently on appeal, the Board will address these claims below. Regarding any other neurological manifestations, the Veteran has specifically denied the neurological symptoms of weakness or loss of bowel or bladder control. In reaching the above conclusions, the Board has not overlooked the Veteran’s statements with regard to the severity of his low back disability. In this regard, the Veteran is competent to report on factual matters of which he had firsthand knowledge, e.g., experiencing chronic pain in his back. See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005). The Veteran has provided lay evidence through written statements throughout the course of his appeal with respect to the presence of pain and the severity of such during his VA examinations. He is competent to provide such statements, and the Board finds that the Veteran’s statements are credible. The Veteran’s reported symptomatology has been noted in the rating decisions above, and the Board has considered the Veteran’s reports with respect to pain in evaluating his assigned rating. With respect to the Rating Schedule, the criteria set forth therein generally require medical expertise where the types of findings required are not readily observable by a lay person. Therefore, the objective medical findings provided by the Veteran’s VA examination reports have been accorded greater probative weight. See Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993) (“[t]he probative value of medical opinion evidence is based on the medical expert’s personal examination of the patient, the physician’s knowledge and skill in analyzing the data, and the medical conclusion that the physician reaches... the credibility and weight to be attached to these opinions [are] within the province of the adjudicator.”). As a preponderance of the evidence is against the award of an increased rating, the benefit-of-the-doubt doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107(b); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1991). 4. Entitlement to an initial rating in excess of 10 percent for radiculopathy of the left lower extremity prior to August 8, 2017 and a rating in excess of 20 percent thereafter. In addition to considering the orthopedic manifestations of a lumbar spine disability, VA regulations also require that consideration be given to any associated objective neurologic abnormalities, which are to be evaluated separately under an appropriate diagnostic code. For the sake of brevity, the Board will refer to the findings contained in the VA and private treatment records, December 2014 VA examination, May 2016 private examination, and August 2017 VA examination, as discussed in detail above. Here, the Veteran is in receipt of a 10 percent for radiculopathy of the left lower extremity involving the sciatic nerve, pursuant to Diagnostic Code 8520 for the period from October 24, 2014 to August 8, 2017, and a rating of 20 percent thereafter. Neurological impairments affecting the sciatic nerve are evaluated under Diagnostic Codes 8520 (paralysis), 8620 (neuritis) and 8720 (neuralgia), using the criteria under Diagnostic Code 8520. For diseases of the peripheral nerves, disability ratings are based on whether there is complete or incomplete paralysis of the particular nerve. The term “incomplete paralysis” 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. See 38 C.F.R. § 4.124a, Diseases of the Peripheral Nerves. When the involvement is wholly sensory, the rating should be for the mild, or at most the moderate degree. Id. Complete paralysis of the sciatic nerve is evidenced by the foot dangled and dropped, no active movement possible of muscles below the knee, flexion of knee weakened or (very rarely) lost. 38 C.F.R. § 4.124a, Diagnostic Code 8520. Under Diagnostic Code 8520, for incomplete paralysis, a 10 percent disability rating is assigned for mild incomplete paralysis. A 20 percent disability rating is assigned for moderate incomplete paralysis. If the condition is considered “moderately severe,” a 40 percent disability rating is provided, and a 60 percent rating is warranted for conditions considered “severe, with marked muscular atrophy.” The Board observes that the words “mild,” “moderate” and “severe” as used in the various diagnostic codes are not defined in the VA Schedule for Rating Disabilities. Rather than applying a mechanical formula, the Board must evaluate all of the evidence, to the end that its decisions are “equitable and just.” 38 C.F.R. § 4.6. The Veteran was initially examined in December 2014 in connection with his most recent claim of entitlement to a higher rating for the low back disability. At that time, the VA examiner noted the Veteran’s muscle strength testing, deep tendon reflexes, and sensory examinations were all normal. Additionally, straight leg raising was negative. Consequently, the examiner failed to provide a diagnosis of radiculopathy for the left extremity. Thereafter, a May 2016 private examination found that the Veteran’s experiences symptoms of his left lower extremity radiculopathy every day, although not constantly. The Veteran reported that the pain is sharp and radiates from his lower back into his left buttock and down his left lower extremity. The Veteran also reports numbness and a “pins and needles” sensation. The private physician specifically attributed the left lower extremity to the service-connected low back disability and characterized it as moderately severe in nature. The Veteran was most recently examined by VA in August 2017. At that time, the VA examiner noted the presence of muscle atrophy in the left thigh but ultimately characterized the Veteran’s radiculopathy of the left lower extremity as moderate in severity. Additionally, the VA and private treatment records dated throughout the appeals period support the findings included in the VA examinations and private examination as discussed. Here, the Board finds that the radiculopathy of the left lower extremity is best rated as mild for the period from October 24, 2014 to May 18, 2016, and moderately severe, thereafter based on the findings of the May 2016 private examination. C.F.R. § 4.124a, Diagnostic Code 8520. However, the evidence does not show that the Veteran’s radiculopathy of the left lower extremity warrants a rating a rating in excess of 10 percent for the initial period (from October 24, 2014 to May 18, 2016) as there is simply no evidence of record to suggest that the Veteran’s left lower extremity radiculopathy is of moderate severity prior to May 18, 2016. Similarly, the evidence does not show that the left lower extremity is severe in nature since May 16, 2016. In addressing why the Veteran is not entitled to the next higher rating of 60 percent associated with severe incomplete paralysis, the Board notes that, at no time during the appeal, did the Veteran present symptoms result in marked muscle atrophy. While the August 2017 VA examiner did note the presence of muscle atrophy, there is no indication it should be considered marked. Further, the VA examiner specifically found the radiculopathy of the left lower extremity was moderate in severity. Additionally, there is no evidence of foot paralysis at any point during the appeal period. Therefore, resolving all reasonable doubt in the Veteran’s favor, a rating of 40 percent for moderately severe radiculopathy of the left lower extremity is warranted, effective from May 18, 2016, but no earlier. 5. Entitlement to a separate rating for radiculopathy of the right lower extremity. As noted above, Diagnostic Code 8520 provides ratings for paralysis of the sciatic nerve. 38 C.F.R. § 4.124a (2017). Disability ratings of 10, 20, and 40 percent are warranted, respectively, for mild, moderate, and moderately severe incomplete paralysis of the sciatic nerve. 38 C.F.R. § 4.124a, Diagnostic Code 8520. A disability rating of 60 percent is warranted for severe incomplete paralysis with marked muscle atrophy. Id. An 80 percent rating is warranted with complete paralysis of the sciatic nerve. Id. Here, the Board finds that the Veteran is also entitled to a separate disability rating for service connection for radiculopathy of the right lower extremity. While the December 2014 VA examiner and the May 2016 private medical examination failed to provide a diagnosis of radiculopathy in the right lower extremity, the Board notes the Veteran was diagnosed with radiculopathy of the right lower extremity during the August 8, 2017 VA examination. At that time, the examiner found the right lower extremity radiculopathy was best characterized as mild incomplete paralysis of the sciatic nerve. Therefore, resolving all reasonable doubt in the Veteran’s favor, the Board finds that a separate 10 percent evaluation is warranted for mild radiculopathy of the right lower extremity under Diagnostic Code 8520, effective from August 8, 2017, the date of the VA examination showing a diagnosis of radiculopathy of the right lower extremity. However, the higher 20 percent evaluation is not warranted under Diagnostic Code 8520 for the right lower extremity radiculopathy as the Veteran’s neurological symptoms are not shown to be moderate in degree. See 38 C.F.R. § 4.124a. 6. Entitlement to an initial compensable rating for left ear hearing loss. The Veteran is also in receipt of a noncompensable rating for left ear hearing loss disability. He contends that his left ear hearing loss is worse than contemplated by the disability rating currently assigned, and seeks a compensable rating. Hearing loss is evaluated under 38 C.F.R. §§ 4.85, 4.86, Diagnostic Code 6100, Tables VI, VIA, and VII of VA’s rating schedule. The Rating Schedule provides a table for rating purposes (Table VI) to determine a Roman numeral designation (I through XI) for hearing impairment, established by a state-licensed audiologist, including a controlled speech discrimination test (Maryland CNC), and based upon a combination of the percent of speech discrimination and the pure tone threshold average, which is the sum of the puretone thresholds at 1000, 2000, 3000, and 4000 Hertz divided by four. 38 C.F.R. § 4.85. Table VII is used to determine the percentage evaluation by combining the Roman numeral designations for hearing impairment of each ear. The horizontal row represents the ear having the poorer hearing and the vertical column represents the ear having the better hearing. Id. Ratings for hearing impairment are derived by the mechanical application of the Rating Schedule to the numeric designations assigned after audiometric evaluations are rendered. Lendenmann v. Principi, 3 Vet. App. 345 (1992). There are certain exceptional patterns of hearing impairment. When the puretone threshold at each of the four specified frequencies (1000, 2000, 3000, and 4000 Hertz) is 55 decibels or more, or when the puretone threshold is 30 decibels or less at 1000 Hertz and 70 decibels or more at 2000 Hertz, the Roman numeral designation for hearing impairment will be determined from either Table VI or Table VIa, whichever results in the higher numeral. Each ear is evaluated separately. 38 C.F.R. § 4.86. In Martinak v. Nicholson, 21 Vet. App. 447, 455 (2007), the Court of Appeals for Veterans Claims (Court) held that, in addition to providing objective test results, a VA audiological examination report must address the functional effects caused by a hearing disability. The Court also noted that VA’s policy requiring VA audiologists to describe the effect of a hearing disability on occupational functioning and daily activities facilitates extraschedular determinations by requiring VA audiologists to provide such information. Martinak, 21 Vet. App. at 455. If impaired hearing is service-connected for only one ear, as applicable here, in order to determine the percentage evaluation from Table VII, the non-service-connected ear will be assigned a Roman numeral designation for hearing impairment of Level I. 38 C.F.R. § 4.85(f). However, if hearing impairment in the service-connected ear is compensable to a degree of 10 percent or more, compensation is payable for hearing impairment in both the service-connected and non-service-connected ears if hearing impairment in the non-service-connected ear is a disability by VA standards. 38 C.F.R. § 3.383(a)(3). After reviewing the evidence of record the Board finds that a compensable rating for left ear hearing loss is not warranted. 38 C.F.R. §4.85, Diagnostic Code 6100. VA treatment records are completely silent for any audiometric findings. In connection with his claim of service connection for this disability, the Veteran was scheduled for a VA audiological examination in November 2014. The results of this examination showed puretone thresholds in decibels of 30, 45, 40, 30 at 1000, 2000, 3000 and 4000 Hertz, respectively. Speech discrimination was 96 percent. The average puretone threshold was 36 percent. These audiometric thresholds do not meet the exceptional pattern of hearing impairment under 38 C.F.R. § 4.86. Therefore, the Veteran’s audio threshold and speech recognition score in the left ear will be applied to Table VI and not Table VIA. Applying the values of the audiological examination to the rating criteria results in a numeric designation no greater than Level I in the left ear. See 38 C.F.R. § 4.85, Table VI. Application of this level of hearing impairment to Table VII at 38 C.F.R. § 4.85 produces a noncompensable rating. The examiner noted the functional impact of the Veteran’s left ear hearing loss as impacting his social life because the Veteran is embarrassed when he cannot hear what is going on around him. Additionally, neither the Veteran nor the attorney representative has argued that the Veteran’s left ear hearing loss disability has worsened in severity since the initial examination was provided. In an initial rating claim, such as in the present appeal, the mere passage of time does not trigger VA’s duty to provide additional medical examination unless there is allegation of deficiency in the evidence of record. Hart, 21 Vet. App. at 508 (citing Palczewski v. Nicholson, 21 Vet. App. 174, 182-83 (2007)). Therefore, the only relevant evidence of record is the November 2014 VA examination report. The preponderance of the evidence of record, as detailed above, is against entitlement to a compensable schedular rating for left ear hearing loss. The evidence of record simply does not allow for a compensable disability rating under the schedular criteria. The Board acknowledges the Veteran’s complaints regarding the functional impact of his hearing loss on his daily life, and the embarrassment he reports as a result of his hearing loss. As noted above, the assignment of the disability rating for hearing impairment is derived from a mechanical formula based on levels of pure tone threshold average and speech discrimination. Furthermore, the Court held that “the rating criteria for hearing loss contemplate the functional effects of decreased hearing and difficulty understanding speech in an everyday work environment”—which “are precisely the effects that VA’s audiometric tests are designed to measure’’— and that “when a claimant’s hearing loss results in an inability to hear or understand speech or to hear other sounds in various contexts, those effects are contemplated by the schedular rating criteria.” See Doucette v. Shulkin, 28 Vet. App. 366, 369 (2017). The Board finds that the VA examination is the most probative evidence regarding the severity of the Veteran’s left ear hearing loss disability. The VA examination was performed by a state-licensed audiologist, and included the controlled speech discrimination test using the Maryland CNC test. The Board does not discount the difficulties the Veteran has with his auditory acuity. However, the Board must base its determination on the basis of the results of the audiology studies of record. Lendenmann v. Principi, 3 Vet. App. 345, 349(1992). After a review of the entire record, the Board finds that the preponderance of the evidence is against the award of an initial compensable rating for left ear hearing loss at any point during the appeals period. As a preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107(b); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1991). REASONS FOR REMAND 1. Entitlement to service connection for a neck disorder. The Veteran is seeking entitlement to service connection for a neck disorder that he states is due to his military service. The Veteran’s service treatment records note complaints of neck pain in service and the available VA and private treatment records both note the existence of chronic neck pain. However, no specific diagnosis has been provided. The Board acknowledges that the Court has previously held that pain alone, without a diagnosed or identifiable underlying malady or condition, does not in and of itself constitute a disability for which service connection may be granted. Sanchez-Benitez v. West, 13 Vet. App. 282 (1999), appeal dismissed in part, and vacated and remanded in part sub nom. Sanchez-Benitez v. Principi, 259 F.3d 1356 (Fed. Cir. 2001). However, the Federal Circuit has recently found that pain alone can be a disability. Specifically, in Saunders v. Wilkie, 886 F.3d 1356 (2018) the Court held that the term “disability” as used in 38 U.S.C. 1110 “refers to the functional impairment of earning capacity, not the underlying cause of said disability,” and held that “pain alone can serve as a functional impairment and therefore qualify as a disability.” In other words, where pain alone results in functional impairment, even if there is no identified underlying diagnosis, it can constitute a disability. The Federal Circuit did emphasize that they were not holding a veteran could demonstrate service connection “simply by asserting subjective pain.... To establish the presence of a disability, the veteran will need to show that her pain reaches the level of functional impairment of earning capacity.” In other words, subjective pain in and of itself will not establish a current disability. Consideration should be given to the impact, or lack thereof, from pain, focusing on evidence of functional limitation caused by pain. Therefore, in light of the recent holding in Saunders, the Veteran should be scheduled for a VA examination to determine whether his cervical spine pain causes functional impairment such that it may qualify as a disability in the event an underlying diagnosis is not provided. 2. Entitlement to service connection for left and right hip disorders, to include as secondary to the service connected low back disability. The Veteran seeks service connection for left and right hip disorders, which he asserts either had their onset in service or are related to his service connected low back disability. In this respect, the Veteran’s attorney has set forth the argument that due to the low back disability, the Veteran is unable to move, which results in obesity that, in turn, results in an altered gait and has caused a bilateral hip disorder. The Board recognizes that obesity may act as an “intermediate step” between a service-connected disability and a current disability that may be service-connected on a secondary basis under 38 C.F.R. § 3.310(a). See VAOPGCPREC 1-2017. However, in order to show secondary service connection is warranted in the instant case under such a theory, the Veteran must show (1) that his service-connected low back disability caused him to become obese; (2) if so, whether the obesity as a result of the service-connected disability was a substantial factor in causing a bilateral hip disorder; and (3) whether the bilateral hip disorder would not have occurred but for obesity caused by the service-connected disability. Id. The Veteran’s service treatment records do not specifically note any complaints, treatment or diagnoses pertaining to either his left or right hips. Following service, an VA treatment and private treatment records note complaints of left and right hip pain and also indicate that the Veteran has undergone replacements of both hips. However, no specific diagnosis has been provided aside from the diagnosed radiculopathy of the left and right lower extremities. Therefore, in light of the recent holding in Saunders noted above, the Veteran should be scheduled for a VA examination to determine whether his left and right hip pain causes functional impairment such that it may qualify as a disability in the event an underlying diagnosis is not provided. Additionally, if the VA examiner determines the Veteran does suffer from a diagnosed right and/ or left hip disorder, he or she must determine whether that left and/ or right hip disorder is separate and distinct from his already service-connected left and right lower extremity radiculopathy. If so, then an etiological opinion must also be provided to determine the nature and etiology of the diagnosed disorder(s), to include whether it is due to or aggravated by the service-connected low back disability. 3. Entitlement to service connection for sleep apnea, to include as due to the service connected low back disability is remanded. The Veteran seeks service connection for sleep apnea, which he asserts either had its onset in service or is related to his service connected low back disability. Specifically, the Veteran’s attorney argues that due to the low back disability, the Veteran is unable to move, which results in obesity that, in turn, results in sleep apnea. The Board recognizes that obesity may act as an “intermediate step” between a service-connected disability and a current disability that may be service-connected on a secondary basis under 38 C.F.R. § 3.310(a). See VAOPGCPREC 1-2017. However, in order to show secondary service connection is warranted in the instant case under such a theory, the Veteran must show (1) that his service-connected low back disability caused him to become obese; (2) if so, whether the obesity as a result of the service-connected disability was a substantial factor in causing sleep apnea; and (3) whether the sleep apnea would not have occurred but for obesity caused by the service-connected disability. Id. Here, the Veteran’s service treatment records do not specifically note any complaints, treatment or diagnoses of sleep apnea. However, his VA treatment records confirm a current diagnosis. The Board finds the RO must afford the Veteran a VA examination to determine the nature and etiology of his currently diagnosed sleep apnea, to include whether it is due to or aggravated by the service-connected low back disability. 4. Entitlement to service connection for right shoulder and left knee disorders. The Veteran is seeking entitlement to service connection for right shoulder and left knee disorders. The service treatment records note the Veteran’s complaints of right shoulder pain and treatment for that pain, diagnosed as possible strain, in January 1983. Additional notations in the Veteran’s service treatment records indicate the right shoulder complaints are a “chronic problem.” Regarding the left knee, the Veteran’s service treatment records do not contain any specific complaints regarding the left knee but the Veteran reports that he has experienced pain on a consistent basis since that time. Following service and in connection with the claims of entitlement to service connection for these disorders, the December 2014 VA examination provided diagnoses of osteoarthritis of the right shoulder and the left knee. Regarding the etiology of these diagnosed disorders, the examiner concluded that the right shoulder and left knee are not due to the Veteran’s military service. As rationale, the examiner stated that there were only transient problems noted during service and the Veteran did not seek treatment for years after his discharge. The Board finds that the opinion in the December 2014 VA examination is incomplete. The examiner classifies the in-service treatment as transient but the in-service treating physician determined the right shoulder was “chronic” in nature. Additionally, the VA examiner relied on the absence of contemporaneous medical treatment records in rejecting the Veteran’s history of symptoms regarding both the right shoulder and left knee without providing an alternative etiology. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). Therefore, an addendum opinion must be obtained regarding the nature and etiology of the diagnosed osteoarthritis of the right shoulder and left knee. 5. Entitlement to a 10 percent evaluation for multiple noncompensable service-connected disabilities pursuant to 38 C.F.R. § 3.324 (2017), prior to October 24, 2014. As to the claim for a 10 percent rating based upon multiple, noncompensable service-connected disabilities, when a veteran is suffering from two or more separate permanent service-connected disabilities of such character as clearly to interfere with normal employability, even though none of the disabilities may be of compensable degree under the rating schedule, the rating agency is authorized to apply a 10 percent rating, but not in combination with any other rating. 38 C.F.R. § 3.324. The provisions of 38 C.F.R. § 3.324 are predicated on the existence solely of noncompensable service-connected disabilities. As such, once a compensable evaluation for any service-connected disability has been awarded, the applicability of 38 C.F.R. § 3.324 is rendered moot. See Butts v. Brown, 5 Vet. App. 532, 541 (1993). To this end, the RO’s consideration of the service connection claims remanded here may directly affect the claim for a 10 percent rating based upon multiple, noncompensable service-connected disabilities prior to October 24, 2014, and thus, render the claim moot. Therefore, this issue must also be remanded for consideration with the inextricably intertwined issues. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (holding that two issues are “inextricably intertwined” when they are so closely tied together that a final Board decision cannot be rendered unless both issues have been considered). 6. Entitlement to a TDIU. Similarly, any decisions regarding the remanded claims could impact the outcome of the TDIU decision. As such, the TDIU claim must also be remanded. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). The matters are REMANDED for the following action: 1. Obtain and associate with the claims file any relevant VA or private treatment records pertaining to the remaining claims on appeal dated from June 2018. All actions to obtain the requested records should be documented fully in the claims file. 2. Schedule the Veteran for a VA examination to determine the nature and etiology of any identified residuals of a cervical spine disorder, to include pain. A complete rationale for all opinions offered must be provided. The examiner should specifically state whether any identified disorder is at least as likely as not (50 percent or greater probability) related to the Veteran’s military service. The examiner must also provide an opinion as to whether any diagnosed cervical spine disorder is at least as likely as not due to or aggravated by the service-connected lumbar spine disability. The examiner must discuss the rationale of the opinion, whether favorable or unfavorable, based on the findings on examination and information obtained from review of the record. 3. Schedule the Veteran for a VA examination to determine whether he currently suffers from a left and/ or right hip disorder and, if so, whether either diagnosed disorder is separate and distinct from his service-connected radiculopathy for the left and right lower extremities. The claims file must be reviewed by the examiner in conjunction with the examination. All tests deemed necessary should be conducted and the results reported. The examiner should then respond to the following: (a.) Does the Veteran have a left and/ or right hip disability, other than radiculopathy? Please explain why or why not. (b.) If the Veteran has a left and/ or a right hip disability other than radiculopathy, is it at least as likely as not (50 percent probability or more) the result of a disease or injury in service? Please explain why or why not, specifically discussing the Veteran’s assertion that he has suffered from pain for a long time. Also, please address the May 2016 private medical examination findings of muscle atrophy of the left thigh. (c.) If the Veteran has a left and/ or right hip disorder but it is not directly related to service, is it at least as likely as not (50 percent probability or more) that it was caused or aggravated by his service-connected low back disability? Please explain why or why not. If you find that the Veteran has a left and/ or right hip disorder that has been caused or aggravated by his low back disability, please attempt to quantify the degree of aggravation beyond the baseline level of disability. In responding to questions (b) and (c), please consider and specifically discuss the Veteran’s assertion that the limitation of mobility caused by his low back disability has led to weight gain which, in turn, caused or aggravated a left and/ or right hip disorder. Please note that the Veteran is competent to report symptoms, treatment, and injuries, and that his reports must be taken into account in formulating the requested opinions. A complete rationale for the opinions rendered must be provided. If you cannot provide the requested opinions without resorting to speculation, please expressly indicate this and state why that is so. 4. Schedule the Veteran for a VA examination to determine the current nature and etiology of the diagnosed sleep apnea, to include whether it is related to service or his service-connected low back disability. The claims file must be reviewed by the examiner in conjunction with the examination. All tests deemed necessary should be conducted and the results reported. The examiner should then respond to the following: (a.) Is it at least as likely as not (50 percent probability or more) the result of a disease or injury in service? Please provide sufficient rationale. (b.) If the Veteran’s sleep apnea is not directly related to service, is it at least as likely as not (50 percent probability or more) that it was caused or aggravated by his service-connected low back disability? Please explain why or why not. (c.) If you find that the Veteran has sleep apnea that has been aggravated by his low back disability, please attempt to quantify the degree of aggravation beyond the baseline level of disability. In responding to questions (b) and (c), please consider and specifically discuss the Veteran’s assertion that the limitation of mobility caused by his low back disability has led to weight gain which, in turn, caused or aggravated his sleep apnea. Please note that the Veteran is competent to report symptoms, treatment, and injuries, and that his reports must be taken into account in formulating the requested opinions. A complete rationale for the opinions rendered must be provided. If you cannot provide the requested opinions without resorting to speculation, please expressly indicate this and state why that is so. 5. Obtain an addendum opinion from a qualified physician regarding the nature and etiology of the right shoulder and left knee disorders. A complete rationale for all opinions offered must be provided. (a.) Regarding the right shoulder disorder, the examiner should specifically state whether the diagnosed osteoarthritis is at least as likely as not (50 percent or greater probability) related to the Veteran’s military service. The examiner must address the in-service complaints and notations of a “chronic” right shoulder disorder, manifested by pain, during service. (b.) Regarding the left knee disorder, the examiner should specifically state whether the diagnosed osteoarthritis is at least as likely as not (50 percent or greater probability) related to the Veteran’s military service. The Veteran’s recollections of observable symptoms must be considered. An absence of contemporaneous medical treatment, standing alone, cannot be the basis for rejecting the lay reports. L. B. CRYAN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T. Berry, Counsel