Citation Nr: 18147166 Decision Date: 11/02/18 Archive Date: 11/02/18 DOCKET NO. 16-21 660 DATE: November 2, 2018 ORDER Entitlement to service connection for sleep apnea is denied. Entitlement to service connection for a right knee disorder is denied. Entitlement to an effective date earlier than July 21, 2006 for service connection for lumbosacral spine degenerative joint disease is denied. Entitlement to an effective date earlier than October 30, 2015 for service connection for left knee medial meniscus tear with medial collateral ligament (MCL) bursitis is denied. Entitlement to an effective date of October 8, 2014, and no earlier, for the grant of service connection for left lower extremity radiculopathy, sciatic nerve, is granted. Entitlement to a 10 percent initial disability rating for lumbosacral spine degenerative joint disease (rated previously as lumbosacral strain), prior to May 21, 2013, is granted. Entitlement to a disability rating higher than 20 percent for lumbosacral spine degenerative joint disease from May 21, 2013 through July 16, 2013 is denied. Entitlement to a disability rating higher than 40 percent for lumbosacral spine degenerative joint disease from July 17, 2013 is denied. Entitlement to an initial disability rating higher than 10 percent for left knee medial meniscal tear with MCL bursitis is denied. Entitlement to a 20 percent initial disability rating for left lower extremity radiculopathy, sciatic nerve, prior to April 25, 2016 is granted. Entitlement to a disability rating higher than 20 percent for left lower extremity radiculopathy, sciatic nerve, from April 25, 2016 is denied. REMANDED Entitlement to service connection for an acquired psychiatric disorder is remanded. Entitlement to service connection for headaches is remanded. Entitlement to a total disability rating based on individual unemployability due to service connected disabilities (TDIU) is remanded. FINDINGS OF FACT 1. The preponderance of the evidence of record is against finding that the Veteran has, or has had at any time during the appeal, a current diagnosis of sleep apnea. 2. The preponderance of the evidence of record is against finding that the Veteran has, or has had at any time during the appeal, a current diagnosis of a right knee disorder. 3. Prior to May 21, 2013, the Veteran's lumbosacral spine degenerative joint disease was manifested primarily by pain. 4. From May 21, 2013 through July 16, 2013, the Veteran's lumbosacral spine degenerative joint disease was manifested primarily by pain and decreased thoracolumbar spine motion that included flexion to no less than 50 degrees and a combined range of motion of no less than 160 degrees. 5. From July 17, 2013, the Veteran's lumbosacral spine degenerative joint disease has been manifested primarily by pain, decreased thoracolumbar spine motion, and IVDS that has caused incapacitating episodes totaling less than a week, but has not been manifested by any ankylosis. 6. The Veteran's left knee medial meniscal tear with MCL bursitis has been manifested primarily by pain and decreased left leg flexion to no less than 120 degrees. 7. Prior to April 25, 2016, the Veteran's left lower extremity radiculopathy, sciatic nerve, was manifested by moderate pain and mild and intermittent numbness in his left lower extremity caused by moderate incomplete paralysis of the sciatic nerve. 8. From April 25, 2016, the Veteran's left lower extremity radiculopathy, sciatic nerve, has continued to be manifested by moderate pain and mild and intermittent of the sciatic nerve. 9. The Veteran's original claim for service connection for lumbosacral spine degenerative joint disease was received on July 17, 1997; the Veteran's service treatment records were added to the claims file in August 2013; the award of service connection for lumbosacral spine degenerative joint disease was based in part on information contained in the service treatment records; however, entitlement to service connection for lumbosacral spine degenerative joint disease did not arise prior to July 21, 2006. 10. The Veteran's original claim for service connection for left knee medial meniscus tear with MCL bursitis was received by VA on October 30, 2015 and VA did not receive any formal informal indication prior to that date that the Veteran wished to file a claim for service connection for a left knee disorder. 11. The award of service connection for left lower extremity radiculopathy, sciatic nerve, arose out of the Veteran's appeal of VA's grant of service connection for lumbosacral spine degenerative joint disease, and, it is ascertainable from the evidence that the Veteran's entitlement to service connection for left lower extremity radiculopathy first arose on October 8, 2014. CONCLUSIONS OF LAW 1. The criteria for service connection for sleep apnea are not met. 38 U.S.C. §§ 1110, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303(a) (2017). 2. The criteria for service connection for a right knee disorder are not met. 38 U.S.C. §§ 1110, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303(a) (2017). 3. The criteria for a 10 percent initial disability rating for lumbosacral spine degenerative joint disease (rated previously as lumbosacral strain) prior to May 21, 2013 are met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107(b) (2012); 38 C.F.R. §§ 3.159, 4.1, 4.3, 4.7, 4.71a, Diagnostic Codes 5235-5242 (2017). 4. The criteria for a disability rating higher than 20 percent for lumbosacral spine degenerative joint disease from May 21, 2013 through July 16, 2013 are not met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107(b) (2012); 38 C.F.R. §§ 3.159, 4.1, 4.3, 4.7, 4.71a, Diagnostic Codes 5235-5242 (2017). 5. The criteria for a disability rating higher than 40 percent for lumbosacral spine degenerative joint disease from July 17, 2013 are not met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107(b) (2012); 38 C.F.R. §§ 3.159, 4.1, 4.3, 4.7, 4.71a, Diagnostic Codes 5235-5243 (2017). 6. The criteria for an initial disability rating higher than 10 percent for left knee medial meniscal tear with MCL bursitis are not met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107(b) (2012); 38 C.F.R. §§ 3.159, 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5260 (2017). 7. The criteria for a 20 percent initial disability rating for left lower extremity radiculopathy, sciatic nerve, prior to April 25, 2016 are met. 38 U.S.C. § 1155, 5103, 5103A, 5107(b) (2012); 38 C.F.R. § 3.159, 4.1, 4.3, 4.7, 4.124a, Diagnostic Code 8520 (2017). 8. The criteria for a disability rating higher than 20 percent for left lower extremity radiculopathy, sciatic nerve, from April 25, 2016 are not met. 38 U.S.C. § 1155, 5103, 5103A, 5107(b) (2012); 38 C.F.R. § 3.159, 4.1, 4.3, 4.7, 4.124a, Diagnostic Code 8520 (2017). 9. The criteria for an effective date earlier than July 21, 2006 for service connection for lumbosacral spine degenerative joint disease are not met. 38 U.S.C. §§ 5101, 5107, 5110, 7111 (2012); 38 C.F.R. §§ 3.1, 3.151, 3.155, 3.400 (2017). 10. The criteria for an effective date earlier than October 30, 2015 for service connection for left knee medial meniscus tear with medial collateral ligament bursitis are not met. 38 U.S.C. §§ 5101, 5107, 5110, 7111 (2012); 38 C.F.R. §§ 3.1, 3.151, 3.155, 3.400 (2017). 11. The criteria for an earlier effective date of October 8, 2014 for service connection for left lower extremity radiculopathy, sciatic nerve, are met. 38 U.S.C. §§ 5101, 5107, 5110, 7111 (2012); 38 C.F.R. §§ 3.1, 3.151, 3.155, 3.400 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty from July 1994 through July 1997. Service Connection In general, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110 (2012); 38 C.F.R. § 3.303 (a) (2017). Service connection requires evidence showing the following elements: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); see also Caluza v. Brown, 7 Vet. App. 498 (1995). Even in instances where the record does not contain affirmative evidence of the occurrence of a disease or injury during service, service connection may still be granted if all of the evidence, including that pertinent to service, establishes that the disability was incurred during service. See 38 U.S.C. § 1113 (b) (2012); 38 C.F.R. § 3.303 (d) (2017); Cosman v. Principi, 3 Vet. App. 503, 505 (1992). Service connection may also be established for a disability that is proximately due to or the result of a service-connected disability. 38 C.F.R. § 3.310 (a) (2017). Also, a disability that is aggravated by a service-connected disability may be service-connected to the degree that the aggravation is shown. 38 C.F.R. § 3.310 (2017); Allen v. Brown, 7 Vet. App. 439 (1995). In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or alternatively, whether a preponderance of the evidence is against the claim, in which case the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 U.S.C. § 5107 (b) (2017). 1. Entitlement to service connection for sleep apnea. The Veteran contends generally that he is entitled to service connection for sleep apnea. He does not raise any specific allegations or theories and his claim is not supported by any buddy statements or lay statements. In conjunction with the same, the service treatment records are entirely silent for any in-service sleep-related complaints for the Veteran or for any objective findings or diagnoses related to any sleep impairment. Post-service treatment records similarly make no reference such complaints or objective findings. Indeed, there is no indication that the Veteran has ever undergone a sleep study or been diagnosed by a treating clinician for sleep apnea. The Board concludes that the Veteran does not have a current sleep apnea diagnosis 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) (2012); 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) (2017). While the Veteran has indicated his general belief that he has sleep apnea, he is not competent to provide a diagnosis for such a disorder. The issue is medically complex, as it requires specialized medical education and the ability to interpret complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board does not assign probative weight to the Veteran's general assertions. The Veteran is not entitled to service connection for sleep apnea. To that extent, this appeal is denied. 2. Entitlement to service connection for a right knee disorder. The Veteran contends also that he is entitled to service connection for an unspecified right knee disorder. He does not raise any specific allegations or theories to support his claim. The service treatment records reflect no in-service complaints by the Veteran of any symptoms in his right knee and they do not indicate any objective findings, diagnoses, or treatment related to the Veteran's right knee. In conjunction with the same, the post-service treatment records make no reference to such complaints, treatment, or findings. Indeed, the Veteran reported during a February 2016 VA examination that he had no complaints related to his right knee. An orthopedic examination conducted at that time revealed no right knee abnormalities. Overall, there is simply no evidence in the record that the Veteran has ever had any problems in his right knee. The Board concludes that the Veteran does not have a current right knee disorder 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) (2012); 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) (2017). The Veteran is not entitled to service connection for a right knee disorder. To that extent also, this appeal is denied. Increased Ratings Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities and are based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. See 38 U.S.C. § 1155 (2012); 38 C.F.R. § 4.1 (2017). Where there is a question as to which of two ratings applies, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower disability rating will be assigned. 38 C.F.R. § 4.7 (2017). In order to evaluate the level of disability and any changes in severity, it is necessary to consider the complete medical history of the veteran's disability. Schafrath v. Derwinski, 1 Vet. App. 589, 594 (1991). In instances where the disability rating being appealed is the initial disability rating assigned with an original grant of service connection, the entire appeal period must be considered. Different disability ratings may be assigned for separate periods of time depending on the facts shown in the evidence, a practice known as "staged ratings." See Fenderson v. West, 12 Vet. App. 119 (1999). Where entitlement to compensation has been established already and an increase in the disability rating is at issue, the veteran's present level of disability is the question of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Staged disability ratings are appropriate in any increased disability rating claim where distinct time periods with different ratable symptoms can be identified in the evidence. The relevant focus for adjudicating an increased disability rating claim is on the evidence concerning the state of the disability from the time period one year before the claim was filed until VA makes a final decision on the claim. Hart v. Mansfield, 21 Vet. App. 505 (2007). When a reasonable doubt arises regarding the degree of disability, such doubt will be resolved in the veteran's favor. 38 C.F.R. §§ 3.102, 4.3 (2017). Once the evidence is assembled, the Board is responsible for determining whether the preponderance of the evidence is against the claim. If so, the claim is denied; if the evidence is in support of the claim or is in equal balance, the claim is allowed. 38 U.S.C. § 5107 (2012); Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). 3. Entitlement to a compensable initial disability rating for lumbosacral spine degenerative joint disease (rated previously as lumbosacral strain) prior to May 21, 2013. Service connection for the Veteran's lumbosacral spine degenerative joint disease was granted to the Veteran, effective from July 21, 2006. A non-compensable initial disability rating was assigned pursuant through May 20, 2013, pursuant to the criteria under 38 C.F.R. § 4.71a, Diagnostic Code (DC) 5237. The criteria for rating most spine disabilities are under DCs 5235 through 5242. Regardless of which of the criteria between DC 5235 through 5242 that VA selects, disabilities characterized under those DCs are rated pursuant to the General Rating Formula for Diseases and Injuries of the Spine (Spine Formula). Under the Spine Formula, a 10 percent disability rating is assigned where the evidence shows a thoracolumbar spine disability that is marked by forward flexion of the thoracolumbar spine that is greater than 60 degrees but not greater than 85 degrees; or, combined range of motion of the thoracolumbar spine that is greater than 120 degrees but not greater than 235 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in an abnormal gait or abnormal spine contour; or, vertebral body fracture with loss of 50 percent or more of the height. A 20 percent disability rating is assigned where the evidence demonstrates forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; a combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 40 percent disability rating is appropriate where there is evidence of forward flexion of the thoracolumbar spine of 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent disability rating is warranted where the disability has resulted in unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent disability rating contemplates unfavorable ankylosis of the entire spine. For VA compensation purposes, the "combined range of motion" refers to the sum of forward flexion, extension, left and right lateral flexion, and left and right rotation. As defined under 38 C.F.R. § 4.71a (Plate V), normal range of motion of the thoracolumbar spine consists of flexion to 90 degrees and extension, bilateral lateral flexion, and bilateral rotation to 30 degrees. The normal combined range of motion of the thoracolumbar spine is 240 degrees. Ankylosis is defined as, "immobility and consolidation of a joint due to disease, injury, or surgical procedure." See Lewis v. Derwinski, 3 Vet. App. 259 (1992). Records that are relevant to the staged appeal period at issue show that the Veteran was treated only sporadically for his low back. In August 2012, he was evaluated for complaints of low back pain by Dr. D.K. A physical examination revealed no evidence of scoliosis and specific range of motion findings are not reported in the record. A May 2013 treatment note shows that the Veteran was followed at that time by Dr. D.K. for ongoing low back pain and spasms. Again, specific range of motion findings are not reported. The evidence shows that the Veteran's low back disability was manifested primarily by pain and spasms during the part of the appeal period at issue. In Burton v. Shinseki, 25 Vet. App. 1 (2011), the United States Court of Appeals for Veterans Claims (Court) held that provisions of 38 C.F.R. § 4.59, which relate to painful motion, are not limited to arthritis and must be considered when raised by the claimant or when reasonably raised by the record. In that context, the Court also held that, when read together, the rating criteria for arthritis (DC 5003) and 38 C.F.R. § 4.59 reflect that painful motion of a major joint (such as the spine) caused by degenerative arthritis is deemed limited motion, even though no actual limitation of motion is demonstrated. See Lichtenfels v. Derwinski, 1 Vet. App. 484, 488 (1991). In view of those holdings, the pain symptoms recorded in Dr. D.K.'s treatment records would appear to represent a compensable degree of disability in the Veteran's spine. Subject to the above, there is simply no evidence in the record that suggests that the Veteran had any loss of thoracolumbar spine motion. Still, in view of the Veteran's reported pain symptoms, the Board concludes that the criteria for a 10 percent initial disability rating, and no higher, are met for the Veteran's lumbosacral spine disability prior to May 21, 2013. The Veteran is entitled to a 10 percent initial disability rating for lumbosacral spine degenerative joint disease prior to May 21, 2013. To that extent, this appeal is granted. 4. Entitlement to a disability rating higher than 20 percent for lumbosacral spine degenerative joint disease from May 21, 2013 through July 16, 2013. The Veteran's lumbosacral spine degenerative joint disease has been rated 20 percent disabling for the part of the appeal period from May 21, 2013 through July 16, 2013, pursuant to the criteria under DC 5237 and the Spine Formula. Records for private treatment received by the Veteran at Able Orthopedics and Sports Medicine note ongoing complaints of low back pain. A physical examination conducted during a May 2013 visit revealed pain during palpation over the spine and decreased thoracolumbar spine motion that included flexion to 50 degrees, extension to 20 degrees, lateral rotation to 25 degrees bilaterally, and lateral flexion to 20 degrees bilaterally (a total combined range of motion of 160 degrees). A repeat examination conducted during a June 2013 follow-up treatment visit revealed ongoing low back pain. No new range of motion findings are reported in that record. Based on the extent of motion demonstrated by the Veteran during the May 2013 treatment visit, the criteria for a disability rating higher than 20 percent under the Spine Formula are not met. Notably, the Veteran's lumbosacral spine disability continued to be manifested by low back pain. Those symptoms are contemplated fully by the assigned 20 percent disability rating for the part of the appeal period at issue. The Veteran is not entitled to a disability rating higher than 20 percent for lumbosacral spine degenerative joint disease for the appeal period from May 21, 2013 through July 16, 2013. To that extent, this appeal is denied. 5. Entitlement to a disability rating higher than 40 percent for lumbosacral spine degenerative joint disease from July 17, 2013. The Veteran's lumbosacral spine degenerative joint disease has been rated 40 percent disabling, effective from July 17, 2013, pursuant to the rating criteria under 38 C.F.R. § 4.71a, DC 5242 and the Spine Formula. The Veteran complained of continuing low back pain during an October 2014 VA spine examination. He reported that pain symptoms were aggravated by bending, physical stress, and periods of prolonged sitting or ambulation. A physical examination revealed thoracolumbar spine forward flexion to 30 degrees with pain beginning at 25 degrees; extension to 10 degrees with pain reported at the end of motion; and, lateral flexion and rotation to 25 degrees with pain beginning from 20 degrees bilaterally for both lateral flexion and rotation. Tests for repetitive motion revealed further decreased flexion to 25 degrees and lateral flexion to 20 degrees bilaterally. Tenderness to palpation was observed over the bilateral lumbosacral paraspinals. Guarding and spasms were observed and resulted in straightening of the lumbar lordosis. A neurological examination revealed decreased muscle strength in both knees. Sensation was decreased in the Veteran's left foot and toes. Still, the examiner opined that the findings were not consistent with any radiculopathies or intervertebral disc syndrome (IVDS). The Veteran did not require assistive devices for ambulating. In terms of function, the examiner opined that the Veteran was unable to bend, lift, and sit for prolonged periods because of flare-ups, consistent with the Veteran's reported functional limitations. During VA treatment in April 2015, the Veteran continued to report low back pain. Demonstrated thoracolumbar spine motion at that time included flexion to 45 degrees, extension to 5 degrees, lateral rotation to 45 degrees bilaterally, and lateral flexion to 10 degrees bilaterally. Demonstrated gait was normal. The Veteran reported that he was receiving vocational rehabilitation training for work as a driving instructor. In November 2015, the Veteran returned for constant low back pain that was causing him to have difficulty with dressing, reaching for things on the floor, negotiating stairs, squats, transfer from low surfaces, prolonged sitting and standing, and prolonged ambulation. A physical examination revealed tenderness during palpation over the spine. Demonstrated ranges of motion included flexion to 30 degrees, extension to 5 degrees, lateral rotation to 45 degrees bilaterally, and lateral flexion to 10 degrees bilaterally. A lumbar spine MRI conducted in December 2015 revealed multi-level degenerative changes, moderate central canal stenosis secondary to disc bulge, mild hypertrophy, and severe left neural foraminal narrowing. During a March 2016 spine examination, the Veteran reported ongoing low back pain that was worse in the morning and aggravated by prolonged sitting, standing, and ambulation. An examination of the spine showed thoracolumbar spine motion that included forward flexion to 25 degrees, extension to 15 degrees, and lateral flexion and rotation to 20 degrees bilaterally. Consistent with earlier examinations, pain was present during weight bearing and palpation over the spine. Again, guarding and spasms were observed and the Veteran's gait was slow and antalgic. No flare-ups were observed during the examination. A neurological examination revealed decreased sensation in the Veteran's left foot and toes, intermittent moderate pain and mild numbness in the left lower extremity. The examiner concluded that findings were consistent with moderate radiculopathy involving the sciatic nerve roots and IVDS. The Veteran used a lumbosacral corset brace for back support regularly. X-rays of the spine revealed findings consistent with arthritis. In terms of function, the examiner noted that the Veteran was employed as a part time driving instructor but that he was unable to work on a full-time basis because of his low back problems. He reported that he was only able to work 15 to 20 hours a week. During re-examination of the spine in June 2016, the Veteran reported ongoing low back pain and thoracolumbar spine motion that included forward flexion to 25 degrees; extension to 10 degrees; and lateral flexion and rotation to 20 degrees bilaterally. Repetitive motion was not productive of further loss of motion or other loss of function. Pain continued to be present during weightbearing and palpation, as was guarding and muscle spasms that were causing ann antalgic gait. No flare-ups were observed during the examination. A neurological examination showed ongoing moderate pain and mild numbness in the Veteran's left lower extremity. Occupationally, the Veteran reported that he was required to give up his part time job as a driving instructor due to his back problems. He continued to report difficulty bending, lifting, sitting for prolonged periods, and standing and ambulating for long periods because of his back pain. The examiner diagnosed lumbosacral spine degenerative joint disease and moderate left lower extremity radiculopathy involving the sciatic nerve group. IVDS was also diagnosed. The Veteran reported that he had three episodes of one to two days of physician prescribed bedrest over the preceding 12 months. Subsequent VA treatment records document ongoing low back pain, but note no new findings, symptoms, or impairment associated with the Veteran's back. The evidence for the part of the appeal period from July 17, 2013 shows that the Veteran's lumbosacral spine disability has not resulted in any ankylosis. Indeed, given the extent of retained painless thoracolumbar spine motion shown by the Veteran during multiple examinations, the evidence does not indicate a disability picture that is consistent with the extent of decreased motion that would be associated with ankylosis. Given the same, the criteria for a disability rating higher than 40 percent under the Spine Formula are not met. As discussed above, the VA examinations conducted in March and June of 2016 revealed IVDS. The criteria for rating disabilities manifested by IVDS are provided under 38 C.F.R. § 4.71a, DC 5243 and the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes (IVDS Formula). Under the IVDS Formula, IVDS that results in incapacitating episodes having a total duration of at least one week but less than two weeks during the past 12 months is assigned a 10 percent disability rating. IVDS that is productive of incapacitating episodes having a total duration of at least two weeks but less than four weeks during the past 12 months is assigned a 20 percent disability rating. IVDS resulting in incapacitating episodes having a total duration of at least four weeks but less than six weeks during the past twelve months is assigned a 40 percent disability rating. IVDS with incapacitating episodes having a total duration of at least six weeks during the past twelve months is assigned a maximum schedular 60 percent disability rating. An "incapacitating episode" is defined as a period of acute signs and symptoms due to IVDS that requires bedrest prescribed by a physician and treatment by a physician. In this case, the Veteran reported during the June 2016 VA examination that, over the preceding 12 months, he had three episodes of one to two days of physician prescribed bedrest (totaling less than a week). Given the same, the criteria for a disability rating higher than 40 percent under the IVDS Formula are not met. The criteria under DC 5243 and the IVDS Formula are not more advantageous to the Veteran. Consideration of an extra-schedular disability rating under 38 C.F.R. § 3.321 (b)(1) for the part of the appeal period under consideration is also not warranted. In Thun v. Peake, 22 Vet. App. 111 (2008), the United States Court of Appeals for Veterans Claims established a three-step inquiry for determining whether an extra-schedular disability rating is warranted by the evidence. First, the Board must determine whether the evidence presents such an exceptional disability picture that the available schedular ratings for that service-connected disability are inadequate. Second, if the schedular rating does not contemplate the Veteran's level of disability and symptomatology and is found inadequate, the Board must determine whether the Veteran'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 veteran'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 Service to determine whether, in order to afford justice, the veteran's disability picture requires the assignment of an extra-schedular disability rating. Applying the first prong under Thun, the Board concludes that the evidence in this case does not show that the Veteran's back disability presents such an exceptional disability picture that the available schedular rating is inadequate. A comparison between the level of severity and symptomatology of the Veteran's lumbosacral spine disability with the established criteria in the Spine Formula and IVDS Formula shows that the applied rating criteria reasonably describe the Veteran's disability level and symptomatology. As such, referral of this case for extra-schedular consideration pursuant to 38 C.F.R. § 3.321 (b)(1) is not warranted. The Veteran is not entitled to a disability rating higher than 40 percent for lumbosacral spine degenerative joint disease for the appeal period from July 17, 2013. To that extent, this appeal is denied. 6. Entitlement to an initial disability rating higher than 10 percent for left knee medial meniscal tear with MCL bursitis. Service connection for left knee medial meniscal tear with MCL bursitis was granted to the Veteran, effective October 30, 2015. A 10 percent initial disability rating was assigned pursuant to the criteria under 38 C.F.R. § 4.71a, DC 5260. The Veteran asserts entitlement to a higher initial disability rating. DC 5260 provides the criteria for rating disabilities due to loss of flexion of the leg. Under those criteria, a 10 percent disability rating is assigned where flexion of the leg is limited to 45 degrees. A 20 percent disability rating is in order where leg flexion is limited to 30 degrees. A maximum schedular 30 percent disability rating is assigned where leg flexion is limited to 15 degrees. For reference, normal range of motion for the knee is defined under the regulations as consisting of extension to zero degrees and flexion to 140 degrees. See 38 C.F.R. § 4.71, Plate II (2017). Records for VA treatment received by the Veteran during the appeal period at issue show that the Veteran was treated periodically for intermittent but ongoing left knee pain. During treatment in November 2015, he stated that his left knee pain was made worse by activities of daily living. The record does not, however, specify as to what activities in particular caused the aggravation in his left knee pain. Physical examinations conducted during VA treatment in November 2015, December 2015, and February 2016 revealed that the Veteran had retained left leg flexion to no less than 120 degrees and full extension to zero degrees. During a February 2016 VA examination, the Veteran reported ongoing left knee pain as well as symptoms of stiffness, swelling, and instability. He reported that he experienced flare-ups that seemed to occur randomly. A physical examination of the left knee revealed full extension to zero degrees and flexion to 120 degrees. Pain was reported at the endpoints of motion and during weightbearing. Strength was decreased during extension of the left leg but was full during flexion. Repetition motion was not productive of further loss of motion or other functions. Although tenderness was observed during palpation over the medial joint line of the left knee, there was no evidence of atrophy, ankylosis, or instability. X-rays of the knee revealed no evidence of degenerative or traumatic arthritis. A February 2015 MRI was reviewed and noted for showing a medical meniscus tear with MCL bursitis. As mentioned above in separate analysis pertaining to the Veteran's right knee, the examination revealed no abnormalities in the right knee. Records for subsequent VA treatment note ongoing left knee pain, but no new complaints or objective findings. The evidence for the appeal period shows that the Veteran's left knee disability has been manifested primarily by pain and decreased left leg motion that has included painless flexion to no less than 120 degrees. Given the extent of motion shown in the evidence, the criteria for a disability rating higher than 10 percent under DC 5260 are not met. The pain symptoms reported by the Veteran are contemplated fully by the 10 percent disability rating that has already been assigned. Although the Veteran reported during the February 2016 examination that he had been having instability in his left knee, repeated physical examinations conducted during VA treatment and the February 2016 examination revealed no objective evidence of instability. As such, a separate disability rating based on instability is not warranted under 38 C.F.R. § 4.71a, DC 5257. Similarly, the evidence shows that the Veteran has retained full and painless extension in his left knee. Accordingly, a separate disability rating based on demonstrated loss of extension is also not warranted under 38 C.F.R. § 4.71a, DC 5261. The Board observes that still other criteria for rating knee disabilities are available under DCs 5256 (for ankylosis), 5258 (for dislocated semilunar cartilage with frequent episodes of locking, pain, and effusion), 5259 (for symptomatic removal of the semilunar cartilage), 5262 (for impairment of the tibia and fibula), and 5263 (for genu recurvatum). The evidence shows that the Veteran's left knee disability has not been manifested by any of the conditions contemplated by these DCs. As such, they are not applicable in this case. The Veteran is not entitled to an initial disability rating higher than 10 percent for left knee medial meniscal tear with MCL bursitis. To that extent also, this appeal is denied. 7. Entitlement to an initial disability rating higher than 10 percent for left lower extremity radiculopathy, sciatic nerve, prior to April 25, 2016. Service connection for left lower extremity radiculopathies involving the sciatic nerve was granted to the Veteran, effective December 15, 2014. A 10 percent initial disability rating has been assigned through April 24, 2016, pursuant to the criteria under 38 C.F.R. § 4.124a, DC 8520. The Veteran claims entitlement to a higher initial disability rating for that period. DC 8520 provides the criteria for rating disabilities due to paralysis of the sciatic nerve. Under those criteria, a 10 percent disability rating is assigned for mild incomplete paralysis of the sciatic nerve. A 20 percent is assigned for moderate incomplete paralysis of the sciatic nerve. A 40 percent disability rating contemplates moderately severe incomplete paralysis of the sciatic nerve. A 60 percent disability rating is warranted for severe incomplete paralysis with marked muscular atrophy. A maximum schedular 80 percent disability rating is assigned for complete paralysis, i.e., the foot dangles and drops, no active movement of the muscles below the knee is possible, and flexion of the knee is weakened or (very rarely) lost. 38 C.F.R. § 4.124a , DC 8520 (2017). During VA treatment in December 2014, the Veteran reported that pain in his low back was radiating into his left lower extremity and that he was having numbness in the toes on his left foot. A neurological examination conducted at that time showed full motor strength in the Veteran's left lower extremity, but decreased sensation in the left L4 dermatome. Attending clinicians diagnosed low back pain with radicular features. Records for subsequent VA treatment received by the Veteran through 2015 document ongoing complaints of radiating low back pain into the Veteran's left lower extremity was intermittent numbness in the Veteran's left foot and toes. A repeat neurological examination conducted in December 2015 revealed decreased strength to 3/5 and decreased reflexes to 1+ in the Veteran's left lower extremity. A neurological examination conducted during the March 2016 spine examination revealed continued radiation of moderate pain into the Veteran's left lower extremity and mildly decreased sensation in the Veteran's left lower extremity, foot, and toes. The examiner concluded that the findings were consistent with a moderate radiculopathy involving the sciatic nerve roots. The evidence for the appeal period prior to April 25, 2016 shows that the Veteran's left lower extremity radiculopathy was manifested by moderate incomplete paralysis of the Veteran's sciatic nerve that caused radiating moderate pain and mild and intermittent loss of sensation in the Veteran's left foot and toes. The criteria for a 20 percent initial disability rating, and no higher, are met for the part of the appeal period at issue. The Veteran is entitled to a 20 percent initial disability rating for left lower extremity radiculopathy, prior to April 25, 2016. To that extent, this appeal is granted. 8. Entitlement to a disability rating higher than 20 percent for left lower extremity radiculopathy, sciatic nerve, from April 25, 2016. Since April 25, 2016, the Veteran's left lower extremity radiculopathy has been rated as being 20 percent disabling pursuant to the criteria under DC 8520. The Veteran asserts also that he is entitled to a higher disability rating for that part of the appeal period. During the June 2016 spine examination, the Veteran continued to report moderate pain and mild numbness in his left lower extremity. The examiner confirmed the previous March 2016 diagnosis of a moderate left lower extremity radiculopathy involving the sciatic nerve group. Records for subsequent VA treatment received by the Veteran do not document any new or additional neurological findings in his left lower extremity. The evidence for the appeal period since April 25, 2016 shows that the Veteran's left lower extremity radiculopathy has continued to be manifested by moderate incomplete paralysis of the Veteran's sciatic nerve that has caused moderate pain and mild loss of sensation in the Veteran's left lower extremity. The criteria for a disability rating higher than 20 percent under DC 8520 are not met. The Veteran is not entitled to a disability rating higher than 20 percent for left lower extremity radiculopathy from April 25, 2016. To that extent, this appeal is denied. Effective Date In order for benefits to be paid to any individual under the laws administered by VA, a specific claim in the form prescribed by the Secretary must be filed. 38 C.F.R. § 3.151 (a) (2017). A "claim" or "application" is defined by VA regulations as "a formal or informal communication in writing requesting a determination of entitlement or evidencing a belief in entitlement to a benefit." 38 C.F.R. § 3.1 (p) (2017). An informal claim is "[a]ny communication or action, indicating intent to apply for one or more benefits . . . ." 38 C.F.R. § 3.155 (a) (2017). Upon receipt of an informal claim, if a formal claim has not been filed, an application form will be forwarded to the claimant for execution. Id. The general rule regarding the assignment of an effective date for an award based on an original claim for VA benefits is that the effective date "shall be fixed in accordance with the facts found, but shall not be earlier than the date of receipt of application therefor." 38 U.S.C. § 5110 (a) (2012); see 38 C.F.R. § 3.400 (to the same effect). An exception to the general rule applies if an application for benefits is received within one year from the date of a veteran's discharge or release from active service, and an award is made on the basis of that application. Only in that limited situation, the effective date of the award is made retroactive to the day following the date of discharge from service. 38 U.S.C. § 5110 (b)(1) (2012); 38 C.F.R. § 3.400 (b)(2) (2017). Otherwise, the effective date will be the later of the date of receipt of claim or the date on which entitlement first arose. 38 U.S.C. § 5110; 38 C.F.R. § 3.400 (b)(2) (2017). 9. Entitlement to an effective date earlier than July 21, 2006 for service connection for lumbosacral spine degenerative joint disease. An October 2014 rating decision granted to the Veteran service connection for lumbosacral spine degenerative joint disease, effective from July 21, 2006. The Veteran asserts entitlement to an earlier effective date. A review of the record reveals that the Veteran did file an initial claim for service connection for a low back disorder that was received by VA on July 17, 1997. That claim was considered and denied by the AOJ in a January 1998 rating decision. The Veteran did not subsequently seek an appeal of the January 1998 denial. As such, the January 1998 denial became final, subject to the regulations for reopening previously denied and final claims under 38 C.F.R. § 3.156. Further review of the record shows that the Veteran's service treatment records were added to the claims file in August 2013, well after the AOJ's initial January 1998 denial. The October 2014 rating decision notes that the service treatment records were reviewed and served as part of the AOJ's basis for awarding service connection for the Veteran lumbosacral spine disability at that time. If at any time after VA issues a decision on a claim, VA receives or associates with the claims file relevant official service department records that existed and had not been associated with the claims file when VA first decided the claim, then VA will reconsider the claim, notwithstanding the regulations concerning reopening claims under 38 C.F.R. § 3.156 (a). 38 C.F.R. § 3.156 (c)(1) (2017). Further, an award based all or in part on the records identified under 38 C.F.R. § 3.156 (c)(1) is effective on the date that entitlement arose or the date VA received the previously decided claim, whichever is later. 38 C.F.R. § 3.156 (c)(3) (emphasis added) (2017). Based on the foregoing facts and regulations, the award of service connection for the Veteran's lumbosacral spine disability arose from reconsideration of the Veteran's original July 17, 1997 claim. As such, the effective date for service connection for lumbosacral spine degenerative joint disease may be fixed to the date of the July 17, 1997 claim or the date on which entitlement to service connection first arose, whichever is later. Here, there was no evidence in the record, either at the time that the Veteran's July 1997 claim was filed or while it was being adjudicated, that the Veteran had been diagnosed or was being treated for a back disorder. Similarly, the Veteran did not raise any specific allegations in his July 1997 claim, nor did he provide any information pertaining to any medical treatment that he had received for his back disability. No lay statements were submitted to support his claim. In short, there was simply no evidence in the record prior to the extant July 21, 2006 effective date that the Veteran had a current low back disability. Indeed, the earliest record in that regard are the 2012 and 2013 private treatment records from Dr. D.K., which note for the first time in the record complaints by the Veteran of low back pain. Under the circumstances, the Board concludes that entitlement to service connection for lumbosacral spine degenerative joint disease did not arise at any time before the current effective date of July 21, 2006. The Veteran is not entitled to an effective date earlier than July 21, 2006 for service connection for lumbosacral spine degenerative joint disease. To that extent, this appeal is denied. 10. Entitlement to an effective date earlier than October 30, 2015 for service connection for left knee medial meniscus tear with MCL bursitis. Service connection for left knee medial meniscus tear with medial collateral ligament bursitis was granted to the Veteran, effective October 30, 2015, in a March 2016 rating decision. That award appears to stem from a claim that was received from the Veteran on that date. The Veteran claims that he is entitled to an earlier effective date. Although the record reflects that numerous submissions and statements were received from the Veteran prior to the October 2015 claim, there is no indication in those submissions that the Veteran was reporting any disorders or symptoms in his left knee, much less, expressing any desire to seek a claim for service connection for a left knee disability. Similarly, treatment records associated with the claims file prior to the October 2015 claim make no reference to any knee-related symptoms or disorders. In view of the foregoing facts and applicable legal authority, the Board concludes that there is no basis upon which to award to the Veteran an effective date earlier than October 30, 2015 for service connection for left knee medial meniscus tear with MCL bursitis. To that extent, this appeal is denied. 11. Entitlement to an effective date earlier than December 15, 2014 for service connection for left lower extremity radiculopathy, sciatic nerve. Service connection for a left lower extremity radiculopathy, sciatic nerve was granted to the Veteran, effective October 30, 2015, in a March 2016 rating decision. The rating decision explained that the effective date was being fixed from the date of the Veteran's claim. The Veteran subsequently appealed and asserted entitlement to an earlier effective date. A June 2016 rating decision granted the earlier effective date of December 15, 2014. As rationale, the AOJ explained that the effective date was being changed to reflect that a radiculopathy was noted during VA treatment on that date. Thus, the AOJ apparently assigned the effective date based on evidence shown during the one year "lookback" period relative to the Veteran's October 30, 2015 claim. As discussed above, service connection for the Veteran's lumbosacral spine degenerative joint disease arises out of reconsideration of the Veteran's original July 17, 1997 claim. To the extent that service connection for the Veteran's left lower extremity radiculopathy arose from the Veteran's appeal of the initial disability rating that was assigned for the Veteran's lumbosacral spine disability, the effective date for service connection for the Veteran's left lower extremity radiculopathy could potentially be fixed to the date of the original July 17, 1997 claim, or, the date on which entitlement first arose, whichever is later. Here, the records show that the Veteran has received regular and ongoing VA and private treatment for back-related problems since 2012. Records for private treatment received from Dr. D.K. in August 2012 and May 2013 reflect that neurological examinations were normal. Indeed, those records make no mention of any neurological complaints by the Veteran. A repeat neurovascular examination conducted in June 2013 was also normal and a lumbar spine MRI revealed no evidence of disc herniation. The October 2014 VA examination noted for the first time the existence of positive neurological findings in the Veteran's left lower extremity. To that end, a neurological examination conducted at that time showed decreased sensation in the Veteran's left foot and toes. Although the examiner opined at that time that the neurological findings were not consistent with a radiculopathy, the examiner gave no rationale or reasoning for that opinion. During subsequent VA treatment in April 2015, the Veteran reported that his low back pain symptoms were radiating into his lower extremities. An MRI conducted in December 2015 showed for the first time multi-level degenerative changes, moderate central canal stenosis secondary to disc bulge, mild hypertrophy, and severe left neural foraminal narrowing. The March 2016 spine examination revealed neurological findings similar to those noted during the October 2014 examination, and based on those findings, the examiner diagnosed a moderate radiculopathy in the Veteran's left lower extremity. Similar findings and the same diagnosis were reported during a June 2016 spine examination. Overall, the records show that the Veteran began reporting neurological manifestations in his left lower extremity during the October 2014 VA spine examination. Repeated neurological examinations conducted with that time have confirmed objective neurological findings that have been diagnosed as a left lower extremity radiculopathy. Based on the evidence, the effective date for service connection for the Veteran's left lower extremity radiculopathy should be fixed from the date of the October 2014 VA spine examination. The Veteran is entitled to an earlier effective date of October 8, 2014 for service connection for left lower extremity radiculopathy, sciatic nerve. To that extent, this appeal is granted. REASONS FOR REMAND 1. Entitlement to service connection for an acquired psychiatric disorder. The Veteran filed his original claim for service connection for an acquired psychiatric disorder, claimed at that time as a mental and physical imbalance disorder, in July 2006. That claim was denied in a November 2006 rating decision. In June 2014, the Veteran reasserted entitlement to service connection for an acquired psychiatric disorder. That submission was treated by the agency of original jurisdiction (AOJ) is a petition to reopen the Veteran's previous claim. The Board notes, however, that the Veteran's service department records were not available for the AOJ's review at the time of the initial November 2006 denial. Indeed, the records show that the Veteran's service treatment records were added to the claims file in August 2013, well after the November 2006 denial. If at any time after VA issues a decision on a claim, VA receives or associates with the claims file relevant official service department records that existed and had not been associated with the claims file when VA first decided the claim, then VA will reconsider the claim, notwithstanding the regulations concerning reopening claims under 38 C.F.R. § 3.156 (a). 38 C.F.R. § 3.156 (c) (2017). Based on the foregoing facts, the Board will reconsider the Veteran's original July 2006 claim. Accordingly, analysis as to whether new and material evidence was received to reopen the Veteran's claim is unnecessary. During a March 2016 VA examination, the Veteran reported that he had received both inpatient and outpatient treatment for bipolar disorder, to include eight or nine different hospitalizations at Jamaica Hospital since 2004. In a January 2017 statement, the Veteran's spouse added that the Veteran was also hospitalized in 2001 for treatment of depression. VA has not undertaken any efforts to obtain the records for the Veteran's mental health hospitalizations at Jamaica Hospital since 2004, the Veteran's hospitalization for depression in 2001, or for treatment received by the Veteran at other facilities. The Board recognizes that the Veteran was invited in a July 2014 letter to provide information pertaining to relevant treatment and that the Veteran did not respond with such information at that time. Still, the Board is of the opinion that the information given by the Veteran during the 2016 VA examination and in his spouse's 2017 letter obligates VA to contact the Veteran to obtain more precise information pertaining to his mental health treatment, and also, to make efforts to obtain the records for the Veteran's hospitalizations at Jamaica Hospital and any other treatment identified by the Veteran. VA should undertake such efforts at this time. 38 C.F.R. § 3.159 (c) (2017). 2. Entitlement to service connection for headaches is remanded. The Veteran claims entitlement to service connection for headaches. His claim is supported by a January 2017 statement from his spouse, who attests that she recalls that the Veteran complained of headaches in letters that he sent home while on active duty and during telephone conversations that took place during his active duty. A March 2017 statement from the Veteran's mother relates that she does not recall the Veteran having problems with headaches prior to his enlistment, but that the Veteran has complained of chronic headaches after his return home from service. In conjunction with the foregoing lay statements, an April 2017 disability benefits questionnaire from Dr. H.S. relates that the Veteran was reporting that he was having three headaches a week that required him to lie down in a dark and quiet room until his headaches and associated sensitivity to light and sound dissipated. The Veteran apparently reported that his headaches began during service and that he believed that they were attributable to stress caused by his mental health. Dr. H.S. diagnosed tension headaches. Relying apparently on the lay statements in the record, Dr. H.S. opined that it is at least as likely as not that the Veteran's tension headaches began during his active duty service. He opined also that the Veteran's headaches are aggravated permanently by his bipolar disorder. Although Dr. H.S. diagnosed tension headaches, his DBQ references no specific objective findings that support his diagnosis, nor does he point to any specific findings in the record. Indeed, the post-service treatment records indicate that the Veteran has never received any evaluation or treatment for his headaches. Under the circumstances, the Veteran should be afforded an examination of his headaches to determine their nature and etiology. 38 C.F.R. § 3.159 (c)(4) (2017). Dr. H.S.'s opinion raises the possibility that the Veteran's claimed headaches are secondary to his alleged bipolar disorder. Where the issue of the Veteran's entitlement to service connection for an acquired psychiatric disorder remains on appeal, it is possible given the evidence that the ultimate disposition of that issue will affect the outcome of the Veteran's claim for service connection for headaches. Given the same, the two issues are inextricably intertwined and the issue of the Veteran's entitlement to service connection for headaches must be deferred pending resolution of the intertwined issue. Henderson v. West, 12 Vet. App. 11, 20 (1998); Harris v. Derwinski, 1 Vet. App. 180 (1991); Parker v. Brown, 7 Vet. App. 116, 118 (1994). 3. Entitlement to TDIU is remanded. During a March 2016 VA examination, the Veteran reported that he was no longer able to work full time hours because of symptoms and physical limitations caused by his lumbosacral spine disability. Still, he reported at that time that he was able to work 15 to 20 hours a week as a part time driving instructor. During a repeat spine examination conducted three months later in June 2016, he reported that he had been required to leave his job as a driving instructor and reported difficulty bending, lifting, sitting for prolonged periods, and standing and ambulating for long periods because of his back pain. A May 2017 private opinion from Dr. H.S. reports that the Veteran was reporting that he was unable to stand or walk more than 20 minutes at a time, sit for more than 30 minutes at a time, and was required to lie down for 30 minute periods three or four times a week because of his back pain. The Veteran apparently reported also that he was unable to lift more than 15 pounds more than only occasionally during a given work day. He related that if he were to engage in such activities too often, he would be required to lie in bed for the rest of the day. Based on the Veteran's reported functional capacity, Dr. H.S. opined that the Veteran's low back disability more likely than not rendered the Veteran incapable of maintaining substantially gainful employment. Dr. H.S.'s opinion is dependent wholly on the Veteran's reported functional impairment and are not accompanied by any objective findings. Indeed, Dr. H.S. does not point to any specific findings in the record to support his conclusions. Under the circumstances, Dr. H.S.'s opinion is incomplete. Nonetheless, the impairment reported by the Veteran combined with Dr. H.S.'s opinion concerning the Veteran's employment capacity suggests that the Veteran may have experienced some additional loss of functional capacity that interferes with his ability to secure and follow a substantially gainful occupation. Under the circumstances, the Veteran should be afforded an examination of his service connected disabilities to determine the extent that they, acting either individually or together, impair the Veteran's functional and occupational capacity. 38 C.F.R. § 3.159 (c)(4) (2017). Additionally, the Board notes that the issue of the Veteran's entitlement to TDIU is dependent upon the outcome of pending issues concerning his entitlement to service connection for an acquired psychiatric disorder and for headaches. As such, the issue of the Veteran's entitlement to TDIU is inextricably intertwined with those issues and must again be deferred pending resolution of those issues. Henderson, 12 Vet. App. at 20; Harris, 1 Vet. App. 180; Parker, 7 Vet. App. at 118 (1994). The matter is REMANDED for the following action: 1. The Veteran should be asked whether he has additional evidence pertaining to his acquired psychiatric disorder, headaches, and/or service connected disabilities, to include records or information pertaining to mental health treatment received by him at Jamaica Hospital and any other treatment providers. Records for relevant VA treatment received by the Veteran since June 2017 should be associated with the record. If such records are not available, such unavailability should be documented in the record. The Veteran and his representative should be notified of unsuccessful efforts to allow them the opportunity to obtain and submit those records for VA review. 2. Obtain the records for mental health treatment received by the Veteran at Jamaica Hospital and for any other treatment identified by the Veteran. If such records are not available, such unavailability should be documented in the record. The Veteran and his representative should be notified of unsuccessful efforts to allow them the opportunity to obtain and submit those records for VA review. 3. Schedule the Veteran for a mental health examination by an appropriate clinician to determine the nature and etiology of the Veteran's acquired psychiatric disorder. The claims file should be reviewed in conjunction with the examination. All disorders exhibited by the Veteran during the appeal period should be identified. The examiner must opine as to whether it is at least as likely as not that any diagnosed disorder was: (1) incurred during the Veteran's active duty service; (2) proximately due to injuries or events incurred by the Veteran during his active duty service; or (3) resulted from or was aggravated by the Veteran's service connected disabilities. 4. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of the Veteran's headaches. The claims file should be reviewed in conjunction with the examination. All disorders exhibited by the Veteran during the appeal period should be identified. The examiner must opine as to whether it is at least as likely as not that any diagnosed disorder was: (1) incurred during the Veteran's active duty service; (2) proximately due to injuries or events incurred by the Veteran during his active duty service; or (3) resulted from or was aggravated by the Veteran's service connected disabilities. 5. Schedule the Veteran for a VA examination to determine the impact that his service-connected disabilities have on his ability to function in an occupational setting. The examiner should specifically comment on the extent to which the Veteran’s service connected disabilities affect his ability to perform the physical and mental acts required for employment, both acting individually and in combination. (Continued on the next page)   6. After completion of the above development, the issues on appeal should be readjudicated. If the determination remains adverse to the Veteran, he and his representative should be furnished with a SSOC and be given an opportunity to respond. DONNIE R. HACHEY Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD D.S. Lee, Counsel