Citation Nr: 18147870 Decision Date: 11/06/18 Archive Date: 11/06/18 DOCKET NO. 17-13 019 DATE: November 6, 2018 ORDER Entitlement to a 40 percent rating for service-connected radiculopathy of the left upper extremity, as secondary to service-connected degenerative disc disease (DDD) of the cervical spine, is granted, subject to the laws and regulations governing the award of monetary benefits. Entitlement to a 30 percent rating for service-connected radiculopathy of the left lower extremity (femoral nerve), as secondary to service-connected DDD of the lumbosacral spine, is granted, subject to the laws and regulations governing the award of monetary benefits. REMANDED Entitlement to an increased evaluation for residuals of a low back injury with DDD of the lumbosacral spine, rated as 10 percent disabling, is remanded. FINDINGS OF FACT 1. Throughout the appeal period, the Veteran’s radiculopathy of the left upper extremity, as secondary to his service-connected DDD of the cervical spine, was productive of symptoms more nearly approximate to severe, incomplete paralysis of the upper radicular group. 2. Throughout the appeal period, the Veteran’s radiculopathy of the left lower extremity (femoral nerve), as secondary to his service-connected DDD of the lumbosacral spine, was productive of symptoms more nearly approximate to severe, incomplete paralysis. CONCLUSIONS OF LAW 1. The criteria for a 40 percent rating, and no more, for radiculopathy of the left upper extremity, as secondary to service-connected DDD of the cervical spine have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. Part 4, including §§ 4.7, 4.124a, Diagnostic Code 8510. 2. The criteria for a 30 percent rating, and no more, for radiculopathy of the left lower extremity (femoral nerve), as secondary to service-connected DDD of the lumbosacral spine have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. Part 4, including §§ 4.7, 4.124a, Diagnostic Code 8526. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 1971 and February 1997. This matter comes before the Board on appeal from an April 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Winston-Salem, North Carolina. As a preliminary matter, in an April 2016 Statement in Support of Claim, the Veteran asserted that he had depression and was unable to work due to his service-connected left upper/lower extremity conditions. The Veteran and his representative should be contacted and informed that if the Veteran seeks to make such claims, that effective March 24, 2015, a claimant for VA benefits must file a claim on the application form prescribed by the Secretary to be considered. See Standard Claims and Appeals Forms final action at 79 Fed.Reg. 57,660 (Sept. 25, 2014). Increased Rating In rating radiculopathy or peripheral nerve injuries and their residuals, attention should be given to the site and character of the injury, the relative impairment and motor function, trophic changes, or sensory disturbances. 38 C.F.R. § 4.120. Under 38 C.F.R. § 4.124a, disability from neurological disorders is rated from 10 to 100 percent in proportion to the impairment of motor, sensory, or mental function. With partial loss of use of one or more extremities from neurological lesions, rating is to be by comparison with mild, moderate, severe, or complete paralysis of the peripheral nerves. The term “incomplete paralysis” indicates a degree of lost or impaired function substantially less than the type of picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. 38 C.F.R. § 4.124a. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. Id. In rating radiculopathy or peripheral nerve disability, neuritis, characterized by loss of reflexes, muscle atrophy, sensory disturbances, and constant pain, at times excruciating, is to be rated on the scale provided for injury of the nerve involved, with a maximum equal to severe, incomplete paralysis. 38 C.F.R. § 4.123. Diagnostic Code 8510 provides the rating criteria for paralysis of the upper radicular group where incomplete paralysis is rated 20 percent when mild, 40 percent (major extremity) and 30 percent (minor extremity) when moderate, and 50 percent (major extremity) and 40 percent (minor extremity) when severe. Complete paralysis, manifested by all movement of the shoulder and elbow lost or severely affected and the hand and wrist movements are unaffected, is rated 70 percent (major extremity) and 60 percent (minor extremity). Diagnostic Code 8526 provides the rating criteria for paralysis of the anterior crural (femoral) nerve where incomplete paralysis is rated 10 percent when mild, 20 percent when moderate and 30 percent when severe. Complete paralysis, manifested by paralysis of the quadriceps extensor muscles, is rated 40 percent. The Board notes that the terms “mild,” “moderate,” and “severe” are not defined in the rating schedule; rather than applying a mechanical formula, VA must evaluate all the evidence to the end that its decisions are equitable and just. 38 C.F.R. § 4.6. Although a medical examiner’s use of descriptive terminology such as “mild” is an element of evidence to be considered by the Board, it is not dispositive of an issue. The Board must evaluate all evidence in arriving at a decision regarding an increased rating. 38 C.F.R. §§ 4.2, 4.6. The Board also notes that the Veteran is service-connected for left lower extremity radiculopathy (sciatic and common peroneal nerves) associated with residuals of low back injury with DDD of the lumbosacral spine. The scope of this appeal only involves the issue of radiculopathy of the left lower extremity (femoral nerve), as secondary to service-connected DDD of the lumbosacral spine. 1. Entitlement to an increased evaluation for radiculopathy of the left upper extremity, as secondary to service-connected DDD of the cervical spine, rated as 20 percent disabling The Veteran contends that he is entitled to a higher rating for his service-connected radiculopathy of the left upper extremity. Pursuant to DC 8510, a 40 percent rating is warranted for incomplete paralysis of the upper radicular group, affecting the minor extremity. Upon review of the record evidence, the Board finds that the Veteran’s radiculopathy of the left upper extremity manifested as chronic pain, numbness, tingling, weakness, and decreased motor function. As such, a 40 percent rating, and no more, is warranted. The Veteran contended in statements dated October 2014 and April 2016 that he had pain, weakness, tingling, and numbness in his left upper extremity. The Veteran asserted that he experienced numbness in three fingers of his left hand. In the October 2014 statement, the Veteran asserted that his physician, Dr. W., informed him that his left hand/finger numbness may persist for years and that “it may take a while for the strength to be restored”. The Veteran asserted that he had interrupted sleep due to severe radiating burning, itching and pain from his left shoulder to his fingers, and that he used two TENS units at night to alleviate the pain. The Veteran asserted having left hand swelling at night that prevented him from closing his hand, presumably to make a fist. The Veteran asserted that he could not use his left hand and that his thumb, index and middle fingers were very sensitive to touch. The Veteran asserted that he had injections in his neck, back and left wrist, as well as physical/occupational therapy, to alleviate pain without relief. He endorsed daily pain rated an 8 out of 10, with medication, without relief. The Veteran reported having left shoulder surgery in June 2015. According to the Veteran, he was unable to lift his left arm from his side further than 40 degrees and no more than 30 degrees when extending his left arm in front of his body. An October 2014 private treatment record indicated that the Veteran was diagnosed with status-post (s/p) C4-C6 anterior cervical discectomy and fusion (ACDF). The Veteran endorsed left hand numbness and exhibited slight weakness in his left hand grip, compared to his right hand. Examination revealed normal bicep and triceps strength. The clinician provided the Veteran “bone stim” and suggested that he resume physical therapy per authorization of his orthopedic surgeon, Dr. J. L. A subsequent October 2014 private treatment note indicated that the Veteran underwent left shoulder arthroscopy with subacromial decompression (SAD) acromioplasty. A review of the medical evidence of record indicates that the Veteran underwent physical therapy sessions, at least twice a month from October 2014 to August 2015 for left shoulder pain. The medical evidence of record is unclear regarding whether the Veteran’s left shoulder pain was related to his October 2014 left shoulder surgery or to his service-connected radiculopathy of the left upper extremity, as secondary to his service-connected DDD of the cervical spine. In March 2015, the Veteran was afforded a VA Peripheral Nerves Conditions examination and was diagnosed with left upper extremity radiculopathy, secondary to his cervical spine condition. The fact that the Veteran is right-hand dominant was noted. The Veteran endorsed worsened numbing and tingling in the left arm. Examination revealed intermittent moderate left upper extremity pain, paresthesias and/or dysesthesias and numbness. Left upper extremity sensation, muscle strength and reflexes were normal. The Veteran exhibited mild, incomplete paralysis of the left upper radicular groups (5th and 6th cervicals). In March 2015, the Veteran was afforded a VA Shoulder and Arms Conditions examination. The Veteran was diagnosed with left shoulder strain; degenerative arthritis; s/p rotator cuff reconstruction with scars and a gunshot wound to upper arm. The Veteran reported daily flare-ups of pain, difficulty sleeping, numbness, and weakness that lasted 6-8 hours. The Veteran described his functional loss as loss of full range of motion, no strength and the inability to lift heavy objects. Muscle strength testing was 4/5. The Hawkin’s Impingement Test was positive. There was no objective evidence of atrophy, crepitus, instability, ankylosis or clavicle, scapula, acromioclavicular (AC) joint or sternoclavicular joint condition. In April 2015, the Veteran was afforded a VA Cervical Spine Conditions examination and was diagnosed with cervical strain with radiculopathy, bilateral upper radicular group and s/p cervical spine surgery with scar. The Veteran’s left upper extremity sensation, muscle strength and reflexes were normal. The Veteran exhibited intermittent moderate pain and paresthesias and/or dysesthesias of the left upper extremity. The Veteran exhibited moderate left upper extremity radiculopathy, involving the C5/C6 nerve roots (upper radicular group). An x-ray showed s/p anterior surgical stabilization C4-C6; otherwise the findings were normal. The examiner remarked that the Veteran’s cervical spine disorder impacted his ability to work because the Veteran was unable to lift heavy objects or perform overhead activities. A June 2015 private electromyography (EMG) showed severe slowing of the median nerves at the left wrist involving motor and sensory (no response) fibers; mild slowing of the ulnar nerves at the left elbow and multi-level mid cervical nerve root irritation. A July 2015 private treatment noted indicated that the Veteran endorsed constant, throbbing, left shoulder pain, rated a 9 out of 10, and decreased mobility. He endorsed numbness and tingling in the left hand and interrupted sleep. The Veteran reported that his left upper extremity symptoms were aggravated by sleeping in any position. The Veteran underwent left wrist carpel tunnel injection of Kenalog 40 per 10 mg 40 mg (1 mL) and Lidocaine HCI 1% per 10 mg (1 mL). His left shoulder active and passive range of motion was flexion to 170 degrees and abduction to 170 degrees. He had full range of motion for the left elbow, wrist and left hand fingers/digits. Neurovascular testing revealed positive Phalen’s test. Left shoulder examination revealed weakness, crepitus, A-L Acromion, positive Yergason’s test (rotator cuff) and a positive Neer Impingement test. In Dr. J. L.’s judgement, a carpal tunnel release plus or minus an ulnar nerve decompression versus transposition may be necessary. Dr. J. L. added that the Veteran clearly had some cervical nerve root irritation which could explain his symptoms, including shoulder pain. A September 2015 VA Consent for Long-Term Opioids for Pain indicated that the Veteran treated his chronic neck pain and left shoulder pain with long-term opioid therapy, specifically, Vicodin. A November 2015 VA treatment note indicated that the Veteran was referred for occupational therapy for chronic left elbow/wrist pain and numbness. A December 2015 VA treatment note indicated that the Veteran reported increased left upper extremity pain. The examiner assessed that the Veteran had “severe sensitivity with range of motion and overreacting nerves”. Further diagnostic testing was recommended. In June 2016, the Veteran’s private physician remarked that the Veteran had left upper extremity numbness and tingling with cervical spine issues. The treatment note indicated that the Veteran’s “neck issues” were “worked up prior to [the Veteran’s left shoulder] surgery”. The Veteran was referred to a physical therapist for pain relief, increased function and education. In the March 2017 VA Form 9, the Veteran asserted that he experienced extreme chronic pain for over 20 years, joint degeneration in the left wrist and extreme limited mobility of the left shoulder (no rotator cup). VA treatment records dated through April 2018 indicated that the Veteran continued to endorse left shoulder pain. In June 2018, the Veteran underwent a VA Shoulder and Arm Conditions examination and was diagnosed with left shoulder arthritis. He endorsed sharp, constant left shoulder pain and left-hand numbness, but denied flare-ups. He reported that he could not lift his left hand above his head, lift heavy objects, apply pressure to his left shoulder or move his left arm in a pivoting motion. Range of motion was flexion to 90 degrees, abduction to 75 degrees, external rotation to 20 degrees and internal rotation to 90 degrees. There was evidence of pain on active and passive range of motion testing. The was evidence of pain on weight bearing testing, but no evidence of pain on non-weight bearing testing. There was no additional loss of function or range of motion after repetitive use (3 repetitions) testing and strength testing was 4/5. There was no muscle atrophy, ankylosis, or instability/dislocation. A rotator cuff condition was suspected and the Veteran had a positive Hawkins’ Impingement test. The Veteran endorsed tenderness to palpation along the anterior aspect of his left shoulder. Examination indicated that pain and abnormal range of motion contributed to functional loss. After carefully reviewing the evidence of record, the Board finds that the probative lay and medical evidence of record reflects that the Veteran’s radiculopathy of the left upper extremity, as secondary to service-connected DDD of the cervical spine has resulted in disability comparable to no more than severe, incomplete paralysis of the upper radicular group. As such, a 40 percent evaluation, and no more, is warranted for severe, incomplete paralysis of the upper radicular group of the left upper extremity (minor extremity). In so finding, the Board observes in October 2014, the Veteran endorsed left hand numbness and a weak left hand grip, compared to his right hand during a follow-up examination after his C4-C6 anterior cervical discectomy and fusion (ACDF). The Veteran also received “bone stim” therapy and was encouraged to resume physical therapy. According to medical literature, bone stimulation therapy uses a device to “promote healing of . . . spinal fusions that have not healed or have difficulty healing.” See http://bonestimulation.com/how-it-works/ (11/02/2018). The medical evidence of record further indicates that the Veteran underwent physical therapy for left shoulder pain at least twice a week for several months after his cervical spine and left shoulder surgery. During an October 2014 physical therapy session, the Veteran continued to endorse limited range of motion of the left upper extremity. The Board observes the March 2015 VA Peripheral Nerves Conditions examination. The Veteran was diagnosed with left upper extremity radiculopathy, secondary to cervical spine condition. The Veteran continued to endorse pain, numbing and tingling in his left arm. His condition was assessed as intermittent moderate left upper extremity pain, paresthesias and/or dysesthesias and numbness. The Veteran exhibited mild incomplete paralysis of the left upper radicular group (5th and 6th cervicals). During a March 2015 VA Shoulder and Arms Conditions examination, the Veteran continued to endorse left upper extremity pain, numbness, weakness, and limited range of motion, substantiated by range of motion testing. The Veteran also reported difficulty sleeping because of his left upper extremity condition. The April 2015 VA Cervical Spine Conditions examination indicated that the Veteran was diagnosed with cervical strain with radiculopathy, bilateral upper radicular group. Although the Veteran exhibited normal left upper extremity sensation, muscle strength, and reflexes; examination revealed moderate left upper extremity radiculopathy, involving the C5/C6 nerve roots (upper radicular group). The Veteran also had intermittent moderate pain and paresthesias and/or dysesthesias in the left upper extremity. The examiner remarked that the Veteran’s cervical spine disorder impacted the Veteran’s ability to work as he was unable to lift heavy objects or perform overhead activities. Most crucially, the June 2015 EMG showed severe slowing of the median nerves at the left wrist involving motor and sensory (no response) fibers and multi-level mid cervical nerve root irritation. The Board observes that there appears to be some overlap between the service-connected cervical radiculopathy and the other neuropathies affecting the median and ulnar nerves. Cumulatively, the medical evidence of record indicates that despite the July 2015 private treatment note indicating normal range of motion for the left elbow, hand, and fingers, the Veteran experienced constant left upper extremity pain as evidenced in the same July 2015 private treatment note and in the April 2016 Statement in Support of Claim. The Veteran consistently rated his left upper extremity pain, at best, an 8 out 10. July 2015 neurovascular testing revealed positive Phalen’s test, left shoulder weakness, crepitus, positive Yergason’s test (rotator cuff) and a positive Neer Impingement test. A July 2015 private treatment note indicated that Dr. J. L. considered an ulnar nerve decompression versus transposition surgical procedure due to the severity of the Veteran’s left upper extremity disorder. In the December 2015 VA examiner’s opinion, the Veteran had “severe sensitivity with range of motion and overreacting nerves” of the left upper extremity. Furthermore, the Veteran endorsed severe radiating burning, itching and pain from his left shoulder to his fingers. Indeed, he endorsed using two TENS units at night to alleviate the pain. Moreover, the Veteran underwent a left wrist injection, “bone stim” therapy, physical therapy and long-term opiod therapy in relation to his left upper extremity symptoms. For these reasons, the type, frequency and severity of the Veteran’s radiculopathy of the left upper extremity, as secondary to service-connected DDD of the cervical spine, is more closely approximate to symptoms contemplated by a 40 percent rating, for severe, incomplete paralysis of the upper radicular group, pursuant to DC 8510. 2. Entitlement to an increased evaluation for radiculopathy of the left lower extremity, as secondary to service-connected DDD of the lumbosacral spine, rated as 10 percent disabling The Veteran contends that he is entitled to a higher rating for his service-connected radiculopathy of the left lower extremity. Pursuant to DC 8526, a 30 percent rating is warranted for severe, incomplete paralysis of the anterior crural (femoral) nerve. Upon review of the record evidence, the Board finds that the Veteran’s radiculopathy of the left lower extremity manifested as chronic pain, numbness, tingling, weakness, and decreased motor function. As such, a 30 percent rating, and no more, is warranted. The Veteran contended in statements dated October 2014 and April 2016 that he had weakness and numbness in his lower back, left leg and the bottom of his left foot. The Veteran asserted that his left lower extremity weakness impeded bending, walking and standing for more than 20 minutes. The Veteran asserted that numbness caused his left leg to “give out 2-3 times a day” and that he felt as though he “carried an object above his knee”. The Veteran asserted that despite an implantation of a permanent subcutaneous nerve stimulator in his spinal cord, he lost “60 percent of his left leg function.” According to the Veteran, he was informed that surgery was the only option for relieving “pressure of the nerve” caused by a bulging disk and that he had a “50/50 chance” that surgery would alleviate his symptoms. The Veteran asserted that his prescription for Gabapentin was increased to 2400mg a day for his left leg condition; he was switched to Pregabalin 150mg twice a day and Naproxen 500mg twice a day, in addition to opioid therapy. The Veteran asserted that he occasionally could not wear socks/shoes due to sensitivity in his foot/toes; he had decreased sensation in his left foot/toes and that when he walked, he was off balance and felt as though a metal plate was in his foot. An October 2014 private podiatry treatment note documented the Veteran’s diagnosed lumbago, radiculopathy and implanted spinal cord stimulator. The Veteran endorsed “loss of feeling”, extreme pain, swelling and “nerve firing” of the left lower extremity. The Veteran also described his left lower extremity symptoms as radiating/shooting pain, rated a 10 out of 10, with tingling and numbness. The examiner noted pathology in the L4, L5 and S1 regions. There was no evidence of foot drop. The Veteran reported treatment with Neurontin 300mg for thirteen years without any improvement in pain. A December 2014 private treatment note indicated that the Veteran’s left lower muscle strength was 4/5, he had strong palpable dorsalis pedis and posterior tibial pulses of the left lower extremity; however, his touch sensation was diminished to the mid-foot distally, verified with 5.07 Semmes Weinstein. In March 2015, the Veteran was afforded a VA Peripheral Nerves Conditions examination and was diagnosed with intervertebral disc syndrome (IVDS), left femoral nerve. The Veteran had intermittent moderate left lower extremity pain, paresthesias and/or dysesthesias and numbness. He also had mild, incomplete paralysis of the anterior crural (femoral) nerve. He had decreased sensation in the left upper anterior thigh (L2), thigh/knee (L3/4) and foot/toes (L5). His left lower extremity muscle strength and reflex were normal. Examination revealed that the Veteran’s gait was antalgic due to IVDS, left femoral and sciatic nerves. There was no evidence of muscle atrophy. In the examiner’s judgment, the Veteran’s peripheral nerve condition impacted his ability to work due to the Veteran’s inability to do extending walking. In March 2015, the Veteran was also afforded a VA Back (Thoracolumbar Spine) Conditions examination. He was diagnosed with lumbar strain; IVDS, bilateral sciatic nerves; IVDS, left femoral nerve; s/p lumbar spine surgery with scar and s/p neurostimulator implant, right upper buttocks with scar. The Veteran endorsed flare-ups of pain and numbness that radiated into his legs and feet. The Veteran exhibited decreased sensation in the left upper anterior thigh (L2), thigh/knee (L3/4) and foot/toes (L5). His left lower extremity muscle strength and reflex were normal. The Veteran had intermittent moderate left lower extremity pain, paresthesias and/or dysesthesias and numbness. He also experienced moderate radiculopathy with involvement of the left L2/L3/L4 nerve roots (femoral nerve) and used a cane to walk. The examiner opined that the Veteran’s thoracolumbar spine condition impacted his ability to work due to the Veteran’s inability to lift heavy objects and perform extensive walking. In the April 2016 Notice of Disagreement (NOD), the Veteran reiterated that in 2016, a “Neu Stimulator” was installed in his upper back to help with nerve pain radiating down his lower back to his left leg which, tremendously reduced his pain. Conversely, the Veteran simultaneously reported that his left leg condition “severely worsened since the ‘Neu Stimulator’ was installed”. The Veteran asserted that he walked with a severe limp and that his left knee is constantly numb. A March 2017 VA treatment note indicated that the Veteran reported having chronic left lower extremity pain for over twenty years. His left knee radiculopathy and extreme left foot nerve damage were noted. The remaining treatment notes dated through April 2018 indicated that the Veteran endorsed a worsened left knee condition, including left knee fatigue. After carefully reviewing the evidence of record, the Board finds that the probative lay and medical evidence of record reflects that the Veteran’s radiculopathy of the left lower extremity, as secondary to service-connected DDD of the lumbosacral spine has resulted in disability comparable to no more than severe, incomplete paralysis of the anterior crural (femoral) nerve. As such, a 30 percent evaluation, and no more, is warranted. In so finding, the Board observes the October 2014 private podiatry treatment note, which indicated that the Veteran had an implanted spinal cord stimulator to promote healing and to alleviate pain associated with his left lower extremity radiculopathy. The Veteran endorsed “loss of feeling”, extreme pain rated a 10 out of 10, swelling and “nerve firing”. The Veteran also endorsed left lower extremity tingling and numbness. The examiner noted the Veteran’s pathology in the L4, L5 and S1 regions. The December 2014 private treatment note indicated that, despite normal left lower extremity muscle strength and strong dorsalis pedis and posterior tibial pulses, the Veteran had diminished touch sensation to the mid-foot distally, verified with 5.07 Semmes Weinstein. The March 2015 VA Peripheral Nerves Conditions examination indicated that the Veteran had decreased sensation in the left upper anterior thigh (L2), thigh/knee (L3/4) and foot/toes (L5). In addition, the examiner noted that the Veteran’s gait was antalgic due to IVDS, left femoral nerve. The March 2015 VA Back (Thoracolumbar Spine) Conditions examination indicated that the Veteran also experienced moderate radiculopathy with involvement of the left L2/L3/L4 nerve roots (femoral nerve) and used a cane to walk. During the examination, the Veteran continued to endorse pain and numbness that radiated into his left lower extremity. Cumulatively, the lay and medical evidence of record indicates that the Veteran continually complained of extreme left lower extremity pain, weakness, numbness and tingling. The Veteran’s assertion that he walked with a severe limp is consistent with the March 2015 VA Peripheral Nerves Condition examiner’s assessment that the Veteran had an antalgic gait due to his IVDS, left femoral nerve. In the April 2016 NOD, the Veteran again asserted that he had radicular pain into his left lower extremity. He asserted that numbness caused his left leg to “give out 2-3 times day”, that when he walked, he felt as though a metal plate was in his foot and that his balance was impaired due to his left lower extremity condition. The Veteran also reported having “little feeling” in his toes and that he occasionally could not wear shoes because of his increased sensitivity in his left foot and toes. Although the April 2016 NOD suggests that Veteran made contrary assertions, namely that the implanted spine cord stimulator simultaneously improved and worsened his pain, the more probative medical evidence and the Veteran’s other assertions regarding the type, frequency and severity of his left lower extremity symptoms, indicate that the Veteran experienced chronic pain, weakness, numbness, and tingling of the left lower extremity more closely approximate to a 30 percent rating. For these reasons, a 30 percent rating, for severe, incomplete paralysis of the anterior crural (femoral) nerve, pursuant to DC 8526, is warranted for the Veteran’s radiculopathy of the left lower extremity, as secondary to service-connected DDD of the lumbosacral spine. REASONS FOR REMAND 3. Entitlement to an increased evaluation for residuals of a low back injury with DDD of the lumbosacral spine, rated as 10 percent disabling, is remanded. The Veteran was last provided a VA examination in conjunction with his service-connected residuals of a low back injury with DDD of the lumbosacral spine in March 2015. The Board finds that the VA examination inadequate, as it pertains to joint testing of the lumbosacral spine. A such, a new examination is required to determine the extent and severity of the Veteran’s residuals of a low back injury and any functional impairment of range of motion of the lumbosacral spine. The Court of Appeals for Veterans Claims (Court) held in Correia v. McDonald, 28 Vet. App. 158 (2016), that the final sentence of 38 C.F.R. § 4.59 requires that VA examinations include joint testing for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint. A review of the claims file reveals that the prior VA examination report includes only active range of motion findings and does not include range of motion findings for passive range of motion. It also does not specify whether the results are weight-bearing or nonweight-bearing. As the previous examination report does not fully satisfy the requirements of Correia and 38 C.F.R. § 4.59, a new examination is necessary to decide the claim. An additional relevant opinion pertaining to flare-ups was also issued by the Court in Sharp v. Shulkin, 29 Vet. App. 26 (2017). The matter is REMANDED for the following action: 1. Schedule the Veteran for an appropriate VA examination to evaluate the service-connected residuals of a low back injury with DDD of the lumbosacral spine. The Veteran’s claims folder must be reviewed by the examiner. (a) In reporting the results of range of motion testing, the examiner should identify any objective evidence of pain, and the degree at which pain begins. (b) Pursuant to Correia v. McDonald, the examination should record the results of range of motion testing for pain on BOTH active and passive motion AND in weight-bearing and nonweight-bearing. If the back cannot be tested on “weight-bearing,” then the examiner must specifically indicate that such testing cannot be done. (c) The examiner should also express an opinion concerning whether there would be additional functional impairment on repeated use or during flare-ups assessed in terms of the degree of additional range of motion loss. In regard to flare-ups (pursuant to Sharp v. Shulkin, 29 Vet. App. 26 (2017)) if the Veteran is not currently experiencing a flare-up, based on relevant information elicited from the Veteran, review of the file, and the current examination results regarding the frequency, duration, characteristics, severity, and functional loss regarding his flares, the examiner is requested to provide an estimate of the Veteran’s functional loss due to flares expressed in terms of the degree of additional range of motion lost, or explain why the examiner cannot do so. [The Board recognizes the difficulty in making such determinations but requests that the examiner provide his or her best estimate based on the examination findings and statements of the Veteran.] TANYA SMITH Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C. Taylor, Associate Counsel