Citation Nr: 18148985 Decision Date: 11/08/18 Archive Date: 11/08/18 DOCKET NO. 15-37 333 DATE: November 8, 2018 ORDER The appeal as to the claim of entitlement to an extension of a temporary total evaluation beyond June 30, 2011, based on the need for convalescence following a March 8, 2011, lumbar spine surgery, is granted. The appeal as to the claim of entitlement to an effective date earlier than September 15, 2010, for the grant of service connection for degenerative disc disease of the lumbar spine is denied. The appeal as to the claim of entitlement to an effective date earlier than April 17, 2015, for the grant of service connection for right lower extremity radiculopathy is denied. The appeal as to the claim of entitlement to an effective date earlier than April 19, 2015, for the grant of service connection for posttraumatic stress disorder (PTSD) is denied. The appeal as to the claim of entitlement to an effective date earlier than April 17, 2015, for the grant of service connection for left lower extremity radiculopathy is dismissed for lack of jurisdiction. The appeal as to the claim of entitlement to a total disability rating based on individual unemployability (TDIU) is dismissed for lack of jurisdiction. REMANDED The appeal as to the claim of entitlement to service connection for hypertension, to include as secondary to a service-connected disability, is remanded. The appeal as to the claim of entitlement to an initial evaluation in excess of 20 percent for service-connected degenerative disc disease of the lumbar spine is remanded. The appeal as to the claim of entitlement to an initial evaluation in excess of 20 percent for service-connected left lower extremity radiculopathy prior to September 29, 2011, in excess of 10 percent from September 29, 2011, and in excess of 20 percent since December 22, 2015, is remanded. The appeal as to the claim of entitlement to an initial evaluation in excess of 10 percent for service-connected right lower extremity radiculopathy from April 17, 2015, and in excess of 20 percent since December 22, 2015, is remanded. The appeal as to the claim of entitlement to an initial evaluation in excess of 30 for service-connected PTSD is remanded. The appeal as to the claim of entitlement to an effective date earlier than April 19, 2015, for the grant of TDIU is remanded. The appeal as to the claim of entitlement to an effective date earlier than April 19, 2015, for the establishment of basic eligibility to Dependents’ Educational Assistance (DEA) is remanded. FINDINGS OF FACT 1. The evidence of record reflects that the Veteran’s lumbar spine surgery of March 8, 2011, resulted in convalescence through September 30, 2011. 2. The Veteran filed his initial claim for service connection for a lumbar spine disability on September 15, 2010. 3. The earliest effective date entitlement arose to service connection for radiculopathy of the right lower extremity was on June 9, 2015. 4. The Veteran’s representative submitted an intent to file a claim for PTSD on April 19, 2015; the Veteran filed a formal claim for service connection for PTSD on April 20, 2015. 5. The Veteran’s claim of entitlement to an earlier effective date for the grant of service connection for left lower extremity radiculopathy was granted in a rating decision issue d by the Agency of Original Jurisdiction (AOJ) in February 2016, with an effective date of September 15, 2010. 6. The Veteran’s claim of entitlement to a TDIU was granted in a rating decision issued by the AOJ in February 2016, with an effective date of April 19, 2015. CONCLUSIONS OF LAW 1. The criteria for establishing entitlement to an extension of a temporary total evaluation beyond through September 30, 2011, but no longer, based on the need for convalescence following a March 8, 2011, lumbar spine surgery, have been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. § 4.30 (2018). 2. The criteria for establishing entitlement to an effective date earlier than September 15, 2010, for the award of service connection for degenerative disc disease of the lumbar spine have not been met. 38 U.S.C. § 5110 (b)(2) (2012); 38 C.F.R. § 3.400(o) (2018). 3. The criteria for establishing entitlement to an effective date earlier than April 17, 2015, for the award of service connection for right lower extremity radiculopathy have not been met. 38 U.S.C. § 5110 (b)(2) (2012); 38 C.F.R. § 3.400(o) (2018). 4. The criteria for establishing entitlement to an effective date earlier than April 19, 2015, for the award of service connection for PTSD have not been met. 38 U.S.C. § 5110 (b)(2) (2012); 38 C.F.R. § 3.400(o) (2018). 5. The Board lacks jurisdiction over the claim of entitlement to an effective date earlier than April 17, 2015, for the award of service connection for left lower extremity radiculopathy, because that claim has been granted and rendered moot. 38 U.S.C. 7104 (a), 7105(d)(5) (2012); 38 C.F.R. 19.7, 20.101, 20.200, 20.202 (2018). 6. The Board lacks jurisdiction over the claim of entitlement to a TDIU, because that claim has been granted and rendered moot. 38 U.S.C. 7104 (a), 7105(d)(5) (2012); 38 C.F.R. 19.7, 20.101, 20.200, 20.202 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service in the United States Army from March 1970 to November 1971. His service was under honorable conditions. These matters are on appeal from December 2014, July 2015, and February 2016 rating decisions. 1. Entitlement to an extension of a temporary total evaluation beyond June 30, 2011, based on the need for convalescence following a March 8, 2011, lumbar spine surgery. The Veteran contends that he is entitled to a temporary total evaluation due to convalescence from the March 8, 2011, surgery from through March 30, 2012. Under 38 C.F.R. § 4.30, a total disability rating (100 percent) will be assigned without regard to other provisions of the rating schedule when it is established by report at hospital discharge (regular discharge or release to non-bed care) or outpatient release that entitlement is warranted, effective from the date of hospital admission or outpatient treatment and continuing for a period of 1, 2, or 3 months from the first day of the month following such hospital discharge or outpatient release. In order to attain the temporary total disability rating, the Veteran must demonstrate that his service-connected disability resulted in: (1) surgery necessitating at least one month of convalescence; (2) surgery with severe postoperative residuals such as incompletely healed surgical wounds, stumps of recent amputations, therapeutic immobilization of one major joint or more, application of a body cast, or the necessity for house confinement, or the necessity for continued use of a wheelchair or crutches (regular weight-bearing prohibited); or (3) immobilization by cast, without surgery, of one major joint or more. 38 C.F.R. § 4.30 (a). An extension of one, two, or three months of a temporary total disability rating may be granted based on the factors enumerated above. 38 C.F.R. § 4.30 (b)(1). Extensions of one to six months beyond the initial six-month temporary total disability rating may be made upon approval of the Veterans Service Center Manager. 38 C.F.R. § 4.30 (b)(2). Convalescence is defined as "the stage of recovery following an attack of disease, a surgical operation, or an injury." Felden v. West, 11 Vet. App. 427, 430 (1998) (citing Dorland's Illustrated Medical Dictionary, p. 374 (28th ed. 1994)). Recovery has been defined as "the act of regaining or returning toward a normal or healthy state." Id. (citing Webster's Medical Desk Dictionary 606 (1986)). The purpose of a temporary total evaluation is to aid a claimant during the immediate post-surgical period when he or she may have incompletely-healed wounds or may be wheelchair-bound, or when there may be similar circumstances indicative of transient incapacitation associated with recuperation from the immediate effects of an operation. 38 C.F.R. § 4.30. Notations in the medical record as to the claimant's incapacity to work after surgery must be considered in the evaluation. Id.; see Seals v. Brown, 8 Vet. App. 291, 296-97 (1995). Upon review of the record, the Veteran is entitled to an extension of his initial temporary total evaluation beyond June 30, 2011, for convalescence following the March 8, 2011, lumbar spine L-4 sacral fusion surgery. In this regard, although the Veteran’s post-surgery records do not reflect that severe convalescence was required beyond June 30, 2011, the medical record notes the Veteran’s incapacity to work through September 30, 2011. In an April 29, 2011, private treatment report, the Veteran reported very good relief of his leg pain and some back ache. The Veteran did not report the use of crutches or a wheelchair, nor did he have incompletely healed surgical wounds. The examiner found that the Veteran was neurologically stable on examination with no complications. Further, the Veteran had no therapeutic immobilization of his lumbar spine, and his condition did not necessitate confinement to the house or any prohibition on weight-bearing during this period. The examiner noted post-surgical scarring without complication. Post-surgical reports, however, do reflect prohibitions on lifting after June 30, 2011. An April 2011 private treatment record shows that the Veteran was limited in his ability to lift no more than 10 pounds prior to June 10, 2011. From June 10, 2011, through September 30, 2011, records demonstrate that while his lifting restriction increased, it was still limited to no more than 30 pounds. Accordingly, the Board finds that the Veteran is entitled to an extension of the temporary total evaluation assigned following the March 8, 2011, lumbar spine surgery through September 30, 2011. Earlier Effective Date The statutory guidelines for the determination of an effective date of an award of disability compensation are set forth in 38 U.S.C. § 5110. Except as otherwise provided, the effective date of an evaluation and award of compensation based on an original claim, a claim reopened after a final disallowance, or a claim for increase will be the date of receipt of the claim or the date entitlement arose, whichever is later. 38 C.F.R. § 3.400 (2018). A specific claim in the form prescribed by the Secretary of VA must be filed for benefits to be paid to any individual under the laws administered by the VA. 38 U.S.C. § 5101 (a) (2012). A "claim" is defined broadly to include 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) (2018); Brannon v. West, 12 Vet. App. 32, 34-5 (1998); Servello v. Derwinski, 3 Vet. App. 196, 199 (1992). Any communication indicating an intent to apply for a benefit under the laws administered by the VA may be considered an informal claim provided it identifies, but not necessarily with specificity, the benefit sought. See 38 C.F.R. § 3.155 (a) (2018); Servello, 3 Vet. App. at 199 (holding that 38 C.F.R. § 3.155 (a) does not contain the word "specifically," and that making such precision a prerequisite to acceptance of a communication as an informal claim would contravene the Court's precedents and public policies underlying the statutory scheme). To determine when a claim was received, the Board must review all communications in the claims file that may be construed as an application or claim. See Quarles v. Derwinski, 3 Vet. App. 129, 134 (1992). 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. If received within one year from the date it was sent to the claimant, it will be considered filed as of the date of receipt of the informal claim. An application is defined 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); see also Rodriguez v. West, 189 F.3d. 1351 (Fed. Cir. 1999), (an expressed intent to claim benefits must be in writing to constitute an informal claim; an oral inquiry does not suffice). 38 C.F.R. § 3.155 (c) provides that when a claim has been filed which meets the requirements of 38 C.F.R. § 3.151 or 38 C.F.R. § 3.152, an informal request for increase or reopening will be accepted as a claim. Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits under laws administered by the Secretary. The Secretary shall consider all information and lay and medical evidence of record in a case before the Secretary with respect to benefits under laws administered by the Secretary. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996), citing Gilbert, 1 Vet. App. at 54. 2. Entitlement to an effective date earlier than September 15, 2010, for the grant of service connection for degenerative disc disease of the lumbar spine. The Veteran contends that the effective date of his assigned degenerative disc disease of the lumbar spine should be prior to September 15, 2010. As above, to determine when a claim was received, the Board must review all communications in the claims file that may be construed as an application or claim. The Veteran’s representative asserts that the treatment records dated January 16, 2009, indicate a diagnosis of degenerative disc disease of the lumbar spine. In this regard, VA medical records cannot be accepted as informal claims for disabilities where, as here, service connection has not been established. The mere presence of medical evidence does not establish intent on the part of a veteran to seek service connection for a condition. See MacPhee v. Nicholson, 459 F.3d 1323, 1326 (Fed. Cir. 2006) (explaining that medical evidence reflecting treatment for and diagnosis of a condition does not constitute, by itself, an informal original claim for compensation under 38 C.F.R. § 3.155 (a), "because the mere presence of the medical evidence does not establish an intent on the part of the veteran to seek" service connection for that condition). Likewise, seeking medical treatment does not establish a claim, to include an informal claim for service connection. Upon review of the record, the first communication from the Veteran that can be interpreted as a request for service connection for a low back disability was the claim received on September 15, 2010. The United States Court of Appeals for Veterans Claims (Court) has acknowledged that the effective date based on an award of service connection is not based on the date of the earliest medical evidence demonstrating a causal connection, but on the date that the application upon which service connection was eventually awarded was filed with VA. See Lalonde v. West, 12 Vet. App. 377, 382 (1999). In addition, the Veteran has not alleged that he filed a claim or had an informal communication asserting entitlement to service connection for a low back disability prior to his most recent claim, received on September 15, 2010. 38 U.S.C. § 5101 (a); 38 C.F.R. §§ 3.1 (b), 3.151(a), 3.155. In fact, the only communication prior to the September 15, 2010, claim is his claim for entitlement to service connection for foot and throat disabilities, received on March 2, 1972. While the Veteran's low back disability may have had its onset a few years before service connection was granted, it is not equivalent to finding a claim for that disability. The provisions of 38 U.S.C. § 5110 explicitly refer to the date an "application" is received. Further, the term "date of receipt" is the date on which a claim, information or evidence was received by VA. 38 C.F.R. § 3.1 (r). As above, the effective date of an award of compensation based on an original claim will be the date of receipt of the claim or the date entitlement arose, whichever is the later. 38 U.S.C. § 5110 (a); 38 C.F.R. §§ 3.400, 3.400(b)(2). Therefore, although he may have been disabled by a low back disability in 2009, because the Veteran submitted a claim for service connection for a low back disability on September 15, 2010, that is the earliest date for which his claim can be granted. Accordingly, the Board finds that the assignment of an earlier effective date for the Veteran’s lumbar spine disability is not warranted. 3. Entitlement to an effective date earlier than April 17, 2015, for the grant of service connection for right lower extremity radiculopathy. The Veteran contends that the effective date of his assigned right lower extremity radiculopathy should be prior to April 17, 2015; specifically, September 15, 2010, the date of receipt of the claim for entitlement to service connection for a low back disability. This position is without merit. As an initial matter, the Veteran filed a claim on September 15, 2010, for, in relevant part, a low back disability. The Veteran never filed a claim for right lower extremity radiculopathy. While the law provides that VA medical records are constructively of record in VA claims, Bell v. Derwinski, 2 Vet. App. 611 (1992), VA adjudicators cannot troll through medical records searching for possible eligibility for service connection claims. See MacPhee v. Nicholson, 459 F.3d 1323, 1326 (Fed. Cir. 2006); see also MacPhee v. Nicholson, 459 F.3d 1323, 1326 (Fed. Cir. 2006). Rather, VA adjudicators review claims that are filed. More importantly, there was insufficient evidence prior to April 17, 2015, from which to support a claim for right lower extremity radiculopathy. During outpatient treatment in January 2009, June 2010, September 2010, and April 2011, the Veteran did not report any pain, numbness or other symptomatology radiating into his right leg. Indeed, the Veteran denied any pain radiating into his right leg. Further, a December 2010 private EMG study is negative for a diagnosis of right lower extremity radiculopathy. Likewise, during the December 2011 VA spine examination, the Veteran denied any pain radiating into his right leg. The Board acknowledges the argument from the Veteran’s representative, that treatment records dated in September 2010 through 2014 show complaints of pain and numbness of the right lower extremity; however, these records and the contemporaneous examination reports do not demonstrate objective findings of right lower extremity radiculopathy. In fact, these treatment records only demonstrate complaints of right lower extremity pain in March 2011, when the Veteran indicated he experienced left lower extremity pain greater than the right lower extremity. Consequently, the June 2015 VA examiner ultimately diagnosed the Veteran with mild right lower extremity radiculopathy. On that basis, the Veteran was assigned a separate rating for right lower extremity radiculopathy. In sum, the facts show that the earliest date entitlement arose for service connection for right lower extremity radiculopathy was on June 9, 2015. 4. Entitlement to an effective date earlier than April 19, 2015, for the grant of service connection for PTSD. The Veteran contends that the effective date of his PTSD should be prior to April 19, 2015. Upon review of the record, the Veteran filed a claim of entitlement to service connection for PTSD on April 20, 2015. The Veteran’s representative filed an intent to file a claim on April 19, 2015. There is no formal claim or any informal statement expressing an intent on the part of the Veteran to seek benefits for a psychiatric disorder prior to April 19, 2015. As such, there is no basis upon which to establish an earlier effective date. In addition, the Veteran has not alleged that he filed a claim or had an informal communication asserting entitlement to service connection for PTSD prior to his representative’s intent to file a claim, received on April 19, 2015. 38 U.S.C. § 5101 (a); 38 C.F.R. §§ 3.1 (b), 3.151(a), 3.155. As above, the effective date of an award of compensation based on an original claim will be the date of receipt of the claim or the date entitlement arose, whichever is the later. 38 U.S.C. § 5110 (a); 38 C.F.R. §§ 3.400, 3.400(b)(2). The mere presence of medical evidence does not establish intent on the part of a veteran to seek service connection for a condition. See Brannon v. West, 12 Vet. App. 32, 35 (1998). Therefore, although he may have been disabled by PTSD prior to April 19, 2015, because the Veteran’s representative submitted an intent to file a claim on April 19, 2015, that is the earliest date for which his claim can be granted. Accordingly, the Board finds that the assignment of an earlier effective date for the Veteran’s PTSD is not warranted. 5. Entitlement to an effective date earlier than April 17, 2015, for the grant of service connection for left lower extremity radiculopathy. See argument Below at Number 6 6. Entitlement to a TDIU. In this case, the Veteran's claim of an effective date earlier than April 17, 2015, for the grant of service connection for left lower extremity radiculopathy was granted in a rating decision issued by the AOJ in February 2016, and the effective of September 15, 2010, was assigned. Likewise, his claim of entitlement to a TDIU was also granted in that rating decision, effective April 15, 2015. The Board may dismiss any appeal which fails to allege specific error of fact or law in the determination being appealed. 38 U.S.C. 7105 (2012); 38 C.F.R. 20.202 (2018). Here, because of the AOJ's action, there no longer remains a case or controversy with respect to this claim. Therefore, the Board lacks jurisdiction over these issues because they have been granted and rendered moot on appeal. 38 U.S.C. 7104, 7105 (2012); 38 C.F.R. 19.7, 20.101, 20.200, 20.202 (2018). Therefore, dismissal of these claims is warranted. REASONS FOR REMAND 1. Entitlement to service connection for hypertension, to include as secondary to a service-connected disability. The Veteran contends that his current hypertension disorder is secondary to his service-connected PTSD and/or diabetes mellitus, type II disorders, including medication prescribed for these disorders. Post-service treatment records demonstrate an initial diagnosis of hypertension in 2010. These records show the Veteran was prescribed several medications for his condition. Contemporaneous records also show that the Veteran was prescribed medication for his service-connected PTSD and diabetes mellitus, type II disabilities. A disability which is proximately due to or the result of a service-connected disease or injury shall be service connected. When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. 38 C.F.R. § 3.310(a) (2018). This includes any increase in severity of a nonservice-connected disease that is proximately due to or the result of a service-connected disability as set forth in 38 C.F.R. § 3.310(b). See also Allen v. Brown, 7 Vet. App. 439 (1995) (en banc). A claimant is also entitled to service connection on a secondary basis when it is shown that a service-connected disability aggravates a nonservice-connected disability. 38 C.F.R. § 3.310; Allen, 7 Vet. App. at 439. Regarding the Veteran’s current hypertension disorder, the December 2015 VA examiner noted that the Veteran had tremendous risk factors for the development of hypertension, including a strong family history of risk-based disease. With respect to aggravation, the examiner concluded that whether the service-connected PTSD aggravated the underlying hypertension was unknown, and such an opinion would be based upon speculation. The examiner’s opinion is inadequate to adjudicate the claim because the examiner failed to address the medications prescribed for the service-connected disorders. In addition, the examiner also failed to provide any rationale regarding his finding that the Veteran’s hypertension was not caused or aggravated by the service-connected psychiatric disorder. Finally, the examiner failed to address whether the service-connected diabetes mellitus, type II disorder caused or aggravated the current hypertension disorder. Accordingly, another medical opinion is necessary to make a determination in this case. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). 2. Entitlement to an initial evaluation in excess of 20 percent for service-connected degenerative disc disease of the lumbar spine. See argument Below at Number 5 3. Entitlement to an initial evaluation in excess of 20 percent for service-connected left lower extremity radiculopathy prior to September 29, 2011, in excess of 10 percent from September 29, 2011, and in excess of 20 percent since December 22, 2015. See argument Below at Number 5 4. Entitlement to an initial evaluation in excess of 10 percent for service-connected right lower extremity radiculopathy from April 17, 2015, and in excess of 20 percent since December 22, 2015. See argument Below at Number 5 5. Entitlement to an initial evaluation in excess of 30 percent for service-connected PTSD. VA's duty to assist includes providing a thorough and contemporaneous medical examination, especially where it is necessary to determine the current level of a disability. Peters v. Brown, 6 Vet. App. 540, 542 (1994). The Board notes that the Veteran was last afforded a VA examination to assess the severity of his service-connected lumbar spine and bilateral lower extremity radiculopathy disabilities, as well as his PTSD in December 2015, June 2015, and December 2015, respectively, approximately three years ago. Subsequently, in several statements and during outpatient treatment, the Veteran asserted that his lumbar spine, bilateral lower extremity disabilities, and PTSD disabilities worsened, suggesting that his symptoms may have increased in severity since the aforementioned VA examinations. Specifically, with respect to his orthopedic disabilities, he reported lessened range of motion and more severe symptoms of his bilateral sciatic nerve. Similarly, regarding his PTSD, the Veteran indicated increased symptoms of depression, social isolation, and impaired memory. In addition, regarding the December 2015 VA lumbar spine examination, the examiner did not perform all the required range of motion testing or explain why the testing was not completed. There was no testing of the range of motion of the lumbar spine for passive motion or non-weight bearing. Thus, the examination report is not adequate for rating purposes. See Correia v. McDonald, No. 13-3238, 2016 WL 3591858 (Vet. App. July 5, 2016). Considering the foregoing, more contemporaneous examinations are warranted to ensure that the record reflects the current severity of the Veteran's service-connected lumbar spine disability, bilateral lower extremity radiculopathy disabilities, and PTSD. See Snuffer v. Gober, 10 Vet. App. 400 (1997). 6. Entitlement to an effective date earlier than April 19, 2015, for the establishment of TDIU. See argument Below at Number 7 7. Entitlement to an effective date earlier than April 19, 2015, for the establishment of DEA. Finally, the claim of entitlement to an effective date earlier than April 19, 2015, for the establishment of TDIU, is inextricably intertwined with the Veteran’s claim of entitlement to increased ratings for lumbar spine, left lower extremity radiculopathy, right lower extremity radiculopathy, and PTSD. Harris v. Derwinski, 1 Vet. App. 181 (1991). Similarly, the claim of entitlement to an effective date earlier than April 19, 2015, for the establishment of DEA, is inextricably intertwined with the Veteran’s claim of entitlement to an effective date earlier than April 19, 2015, for the establishment of TDIU. Id. As this claim is being remanded, updated VA outpatient treatment records should also be obtained. 38 C.F.R. § 3.159. The matters are REMANDED for the following actions: 1. Undertake appropriate development to obtain any outstanding records pertinent to the Veteran's claims, to include VA outpatient treatment records from January 2016, to the present, and any private treatment records identified by the Veteran. If any requested records are unavailable, or the search for such records otherwise yields negative results, that fact should be clearly documented in the record and the Veteran so notified in accordance with 38 C.F.R. § 3.159(e). All steps taken to attempt to obtain the above records should clearly be documented in the record. 2. Once the record is developed to the extent possible, all pertinent evidence of record must be made available to and reviewed by an appropriate VA physician who has not provided a prior opinion in this case. The Veteran need not appear for an examination unless deemed necessary by the physician assigned to offer an opinion. Following review of the record, the physician should state a medical opinion with respect to hypertension present during the period of the claim, as to whether it is at least as likely as not (i.e., at least 50 percent probable) that the hypertension disorder was caused or permanently worsened by the service-connected PTSD and/or diabetes mellitus, type II disorder, to include medications prescribed for the service-connected disabilities. If the physician believes that a hypertension disorder was permanently worsened by a service-connected disorder(s), to include medication prescribed for the service-connected disorder(s), the physician should attempt to identify the baseline level of disability that existed prior to the onset of aggravation and the extent of disability that is attributable to aggravation. A complete rationale must be provided for all opinions offered. If an opinion cannot be offered without resort to mere speculation, the examiner must fully explain why this is the case and identify what additional evidence, if any, would allow for a more definitive opinion. Another examination of the Veteran should only be performed if deemed necessary by the physician providing the opinions. 3. Schedule the Veteran for an examination by an appropriate physician to assess the nature and severity of his service-connected lumbar spine disability. The examiner should thoroughly review the record and should note that review in the report. The examiner should also consider the Veteran's assertions and complaints. All indicated studies should be completed, and all clinical findings reported in detail. The examiner is requested to describe all manifestations and symptoms of the lumbar spine disability, as well as information required for rating purposes, including range of motion measurements. The examiner should be directed to perform range of motion testing to determine the extent of limitation of motion due to pain on active motion and passive motion, and with weight-bearing and without weight-bearing. If the examiner is unable to conduct the required testing or concludes that the required testing is not necessary, he or she should be directed to clearly explain why that is so. The examiner should also address whether there is forward flexion of the thoracolumbar spine to 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine; or, unfavorable ankylosis of the entire thoracolumbar spine; or unfavorable ankylosis of the entire spine. A complete rationale must be provided for all opinions offered. If an opinion cannot be offered without resort to mere speculation, the examiner must fully explain why this is the case and identify what additional evidence, if any, would allow for a more definitive opinion. 4. Schedule the Veteran for an examination by an appropriate physician to assess the nature and severity of his service-connected left and right lower extremity radiculopathy disabilities. The examiner should thoroughly review the record and should note that review in the report. The examiner should also consider the Veteran's assertions and complaints. All indicated studies should be completed, and all clinical findings reported in detail. The examiner is requested to describe all manifestations and symptoms of the bilateral lower extremity radiculopathy disabilities, including whether there is mild, moderate, moderately severe, incomplete, or paralysis of the sciatic nerve of the right and left lower extremities during each stage of the appeal. A complete rationale must be provided for all opinions offered. If an opinion cannot be offered without resort to mere speculation, the examiner must fully explain why this is the case and identify what additional evidence, if any, would allow for a more definitive opinion. 5. Schedule the Veteran for an examination by an appropriate physician to assess the nature and severity of his service-connected PTSD. The examiner should thoroughly review the record and should note that review in the report. The examiner should also consider the Veteran's assertions and complaints. All indicated studies should be completed, and all clinical findings reported in detail. The examiner is requested to describe all manifestations and symptoms of the PTSD. The Veteran's lay assertions must be fully considered and discussed. The examiner is to opine as to the degree of occupational and social impairment resulting from the Veteran's service-connected PTSD. If an opinion cannot be offered without resort to mere speculation, the examiner should fully explain why this is the case and identify what additional information or evidence, if any, would allow for a more definitive opinion. A complete rationale must be provided for all opinions offered. If an opinion cannot be offered without resort to mere speculation, the examiner must fully explain why this is the case and identify what additional evidence, if any, would allow for a more definitive opinion. 6. The AOJ should ensure that the Veteran is provided with adequate notice of the date and place of all scheduled examinations. A copy of all notifications, including the address where the notice was sent, must be associated with the record if the Veteran fails to report for any examination. The Veteran is to be advised that failure to report for a scheduled VA examination without good cause may have adverse effects on his claim. 7. Then, the AOJ should readjudicate the issues on appeal. If the benefits sought on appeal are not granted to the Veteran’s satisfaction, he and his representative should be provided a supplemental statement of the case and an appropriate period of time for response before the case is returned to the Board for further appellate action. B. MULLINS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Sara Schinnerer, Counsel