Citation Nr: 18146045 Decision Date: 10/30/18 Archive Date: 10/30/18 DOCKET NO. 16-36 359 DATE: October 30, 2018 REMANDED Entitlement to service connection for numbness of the left hand, to include as secondary to service connected disabilities, is remanded Entitlement to service connection for numbness of the right hand, to include as secondary to service connected disabilities, is remanded Entitlement to service connection for numbness of the left foot, to include as secondary to service connected disabilities, is remanded. Entitlement to service connection for numbness of the left foot, to include as secondary to service connected disabilities, is remanded. Entitlement to a rating in excess of 20 percent disabling for lumbar spine disability, is remanded. Entitlement to a rating in excess of 10 percent for degenerative joint disease of the cervical spine, is remanded. Entitlement to total disability individual unemployability (TDIU), is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1992 to November 1994. These matters come before the Board of Veterans' Appeals (Board) on appeal from December 2012 rating decisions from the Department of Veterans Affairs (VA) Regional Office (RO) in Columbia, South Carolina. In accordance with the Veteran’s appealed claims for service connection and increased rating, the Veteran was scheduled for an examination in July 2017. A June 2017 letter informed the Veteran about his VA examinations. In July 2017, VA received notice that the Veteran failed to appear for his scheduled examinations. In July 2017 the Veteran contacted the VA to advise that he was out of town at the time of the scheduled examination and requested a new examination date. In an April 2018, the Veteran advised the VA he had issues with regards to getting to his examinations because the notification letters had been getting to him after the date of the scheduled examinations. The Board finds that Veteran being out of town at the time of his scheduled VA examination, constitutes good cause for why the Veteran failed to appear for his examinations and that he should be afforded another opportunity to have his examinations performed. Therefore, a new examination is necessary. A decision cannot be entered on the claim of entitlement to a total disability evaluation based on individual unemployability due to service-connected disorders until the remanded issues have been resolved. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). The matters are REMANDED for the following action: 1. Obtain and associate with the Veteran’s claims file any outstanding VA treatment records. 2. If possible, the Veteran himself should submit any pertinent new evidence regarding the conditions at issue in order to expedite the claim. 3. Following completion of the above, schedule the Veteran for a VA orthopedic examination with a qualified examiner to address the current severity of his lumbar and cervical spine disabilities. The examiner must conduct range of motion testing of the lumbar and cervical spine, specifically noting whether (upon repetitive motion) there is objective evidence of pain, weakened movement, excess fatigability, or incoordination on movement, including during flare-ups. If pain on motion is observed, the examiner should indicate the point at which pain begins. The examiner must estimate the loss of range of motion during flare ups and also after repeated use. The examiner is to specifically test the range of motion in active motion, passive motion, weight-bearing, and nonweight-bearing, if possible. If the examiner is unable to conduct the required testing or concludes that the required testing is not necessary in this case, he or she should clearly explain why that is so. The examiner must also discuss the functional effects of the Veteran’s service-connected disabilities relative to his ability to obtain and maintain substantially gainful employment. The examiner should specifically discuss the functional impact of the Veteran’s lumbar and cervical spine disabilities. The examiner should include a discussion addressing the limitations and restrictions imposed by the Veteran’s service-connected disabilities on such work activities as sitting, standing, walking, lifting, carrying, pushing, and pulling. 4. Schedule the Veteran for a VA examination to determine the nature and etiology of any current numbness/tingling of the hands/feet. All indicated tests and studies, to include EMG/NCV testing, should be performed and all findings should be reported in detail. The entire record must be made available to the examiner and the examiner should note such review in his/her report. The examiner should provide the following opinions: a) Is it at least as likely as not (50 percent probability or greater) that any current numbness/tingling in the hands/feet, if found, had its onset in service or is otherwise related to the Veteran’s service? b) Is it as likely as not (50 percent probability or greater) that any current numbness/tingling in the hands/feet is caused by the service-connected cervical/lumbar spine disorder or any other service-connected disability? c) If not, is it at least as likely as not (50 percent probability or greater) that any current numbness/tingling in the hands/feet is aggravated (permanently worsened) by the service-connected cervical/lumbar spine or any other service connected? If aggravation is found, to the extent that is possible, the examiner is requested to provide an opinion as to approximate baseline level of severity of the nonservice-connected disorder before the onset of aggravation. A complete and fully explanatory rationale must be provided for any opinion offered. If any opinion cannot be rendered without resorting to speculation, the examiner must state whether the need to speculate is caused by a deficiency in the state of general medical knowledge, i.e., no one could respond given medical science and the known facts, or by a deficiency in the record or the examiner, i.e., additional facts are required, or the examiner does not have the needed knowledge or training. 5. The Veteran is hereby notified that it is his responsibility to report for any scheduled examination and to cooperate in the development of the claims, and that the consequences for failure to report for a VA examination without good cause may include denial of the claims. 38 C.F.R. §§ 3.158, 3.655. In the event that the Veteran does not report for the scheduled examination, documentation must be obtained which shows that notice scheduling the examination was sent to the last known address. It must also be indicated whether any notice that was sent was returned as undeliverable. L.M. BARNARD Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Department of Veterans Affairs