Citation Nr: 18152144 Decision Date: 11/21/18 Archive Date: 11/21/18 DOCKET NO. 16-62 531 DATE: November 21, 2018 ORDER New and material evidence has been submitted to reopen a claim of entitlement to service connection for a right hip disorder. Entitlement to service connection for a left shoulder disorder is denied. Entitlement to service connection for a right shoulder disorder is denied. Entitlement to service connection for a cervical spine disorder is denied. Entitlement to service connection for a left ankle disorder is denied. Entitlement to service connection for a right ankle disorder is denied. Entitlement to service connection for left ear hearing loss is denied. Entitlement to an initial compensable rating for a right ear hearing loss is denied. Entitlement to a rating greater than 30 percent for nephrolithiasis is denied. REMANDED Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder, anxiety, and depression is remanded. Entitlement to service connection for a right hip disorder is remanded. Entitlement to service connection for a heart disorder is remanded. Entitlement to a rating greater than 40 percent for lumbar paravertebral myositis is remanded. Entitlement to a compensable rating for a left hip disorder is remanded. Entitlement to a total disability rating based on individual unemployability is remanded. FINDINGS OF FACT 1. In February 1999, VA denied entitlement to service connection for a right hip disorder and the Veteran did not perfect a timely appeal; new evidence submitted since that time relates to an unestablished fact and raises a reasonable possibility of substantiating the claim. 2. The preponderance of the probative evidence is against finding that the Veteran has a current left shoulder disorder related to active service or events therein; and there is no evidence of left shoulder arthritis manifested to a compensable degree within one year following discharge from active duty. 3. The preponderance of the probative evidence is against finding that the Veteran has a current right shoulder disorder related to active service or events therein; and there is no evidence of right shoulder arthritis manifested to a compensable degree within one year following discharge from active duty. 4. The preponderance of the probative evidence is against finding that the Veteran’s current cervical spine disorder is related to active service or events therein; and there is no evidence of cervical spine arthritis manifested to a compensable degree within one year following discharge from active duty. 5. The preponderance of the evidence is against finding that the Veteran has a current left ankle disorder that is related to active service or events therein; and there is no evidence of left ankle arthritis manifested to a compensable degree within one year following discharge from active duty. 6. The preponderance of the evidence is against finding that the Veteran has a current right ankle disorder that is related to active service or events therein; and there is no evidence of right ankle arthritis manifested to a compensable degree within one year following discharge from active duty. 7. The Veteran does not have a left ear hearing loss disability for VA purposes. 8. On VA examination in February 2016, the Veteran had level I hearing on the right; the paired organ rule is not for application and the nonservice-connected left ear is assigned a Roman numeral designation of I. 9. The Veteran’s nephrolithiasis is not manifested by renal dysfunction with constant albuminuria with some edema; or, definite decrease in kidney function; or, hypertension at least 40 percent disabling under Diagnostic Code 7101. CONCLUSIONS OF LAW 1. The February 1999 rating decision is final; new and material evidence has been submitted to reopen a claim of entitlement to service connection for a right hip disorder. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. §§ 3.156, 20.1103. 2. A left shoulder disorder was neither incurred during active service, nor may left shoulder arthritis be presumed to have been incurred therein. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.307, 3.309(a). 3. A right shoulder disorder was neither incurred during active service, nor may right shoulder arthritis be presumed to have been incurred therein. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.307, 3.309(a). 4. A cervical spine disorder was neither incurred during active service nor may cervical spine arthritis be presumed to have been incurred therein. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.307, 3.309(a). 5. A left ankle disorder was neither incurred during active service, nor may left ankle arthritis be presumed to have been incurred therein. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.307, 3.309(a). 6. A right ankle disorder was neither incurred during active service, nor may right ankle arthritis be presumed to have been incurred therein. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.307, 3.309(a). 7. A left ear hearing loss disability was neither incurred in active service, nor may left ear sensorineural hearing loss be presumed to have been incurred therein. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.307, 3.309(a), 3.385. 8. The criteria for an initial compensable rating for a right ear hearing loss are not met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.383, 4.85, Diagnostic Code 6100, 4.86. 9. The criteria for entitlement to a rating greater than 30 percent for nephrolithiasis are not met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.115a, 4.115b, Diagnostic Codes 7508, 7509. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from February 1988 to February 1998. The Veteran submitted additional evidence in December 2016. Automatic waiver applies. 38 U.S.C. § 7105(e). New and Material Evidence Right hip disorder In February 1999, VA denied entitlement to service connection for a right hip disorder, essentially based on a finding that there was no evidence showing the current right hip disorder was incurred in service. The Veteran did not appeal the decision and it is final. 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. In August 2015, the Veteran requested to reopen his claim. In March 2016, VA determined that new and material evidence had not been submitted to reopen the claim. The Veteran disagreed and perfected this appeal. A claimant may reopen a finally adjudicated claim by submitting new and material evidence. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). New evidence means existing evidence not previously submitted to agency decisionmakers. Material evidence means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened, and must raise a reasonable possibility of substantiating the claim. Id. In Shade v. Shinseki, 24 Vet. App. 110 (2010), the United States Court of Appeals for Veterans Claims (Court) interpreted the language of 38 C.F.R. § 3.156(a) as creating a low threshold and viewed the phrase “raises a reasonable possibility of substantiating the claim” as “enabling rather than precluding reopening.” At the time of the February 1999 decision, pertinent evidence included service treatment records and a VA examination. Service treatment records show complaints of left hip pain following a road march in 1996, but are negative for any findings of a right hip injury or chronic right hip disorder. On VA examination in December 1998, the Veteran reported that while doing a road march he fell in a one-foot hole with his right leg and injured his right hip, muscles and low back. X-rays of the right hip showed normal findings. The diagnosis was right hip subtrochanteric bursitis. Evidence submitted since the February 1999 decision includes a July 2015 statement from the Veteran’s treating physician, Dr. Q., who states that the Veteran has low back pain and other symptoms radiating to his hips. The physician goes on to state that the Veteran presents with severe musculoskeletal disorders which are “more probable” (sic) than not secondary to his military service. On review, this evidence is new. It is also material in that it relates to an unestablished fact and raises a reasonable possibility of substantiating the claim. Accordingly, it is reopened herein. 38 C.F.R. § 3.156; Shade. Service Connection Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active service, even if the disability was initially diagnosed after service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Certain chronic diseases, including arthritis and sensorineural hearing loss, will be presumed related to service if they were noted as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if continuity of the same symptomatology has existed since service, with no intervening cause. 38 U.S.C. §§ 1101, 1112, 1113, 1137; Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2012); Fountain v. McDonald, 27 Vet. App. 258 (2015); 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a). Entitlement to service connection for a left shoulder disorder In March 2016, VA denied entitlement to service connection for a left shoulder disorder. The Veteran disagreed and perfected this appeal. Service treatment records show that at his enlistment examination in January 1988, the Veteran reported a left clavicle fracture at age 10. On clinical evaluation, the upper extremities were reported as normal and he is presumed sound. 38 C.F.R. § 3.304(b). Service treatment records are negative for complaints related to the left shoulder and on separation examination; the upper extremities were reported as normal. In July 2015, Dr. Q. indicated that the Veteran had neck and high back pain radiating to his shoulders. The examiner did not provide a specific diagnosis related to the left shoulder but stated that the Veteran’s severe musculoskeletal diseases were more probable than not secondary to his military service. The Veteran underwent a VA shoulder examination in February 2016. The examiner stated there was evidence of arthritis in both shoulders; however, bilateral shoulder x-rays taken at that time were reported as normal. Even assuming the existence of a current left shoulder disorder, the record does not contain any probative evidence relating such a disorder to active service or events therein. In making this determination, the Board acknowledges the July 2015 private statement from Dr. Q, but the examiner provided neither a specific diagnosis pertaining to the shoulder, nor any rationale for his opinion. As such, it is not probative. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (the probative value of a medical opinion comes from its reasoning); see also Prejean v. West, 13 Vet. App. 444, 448-9 (2000) (the factors for assessing the probative value of a medical opinion are the physician's access to the claims file and the thoroughness and detail of the opinion). There is also no evidence that left shoulder arthritis was manifested to a compensable degree within one year following discharge from active service. The preponderance of the evidence is against the claim and the doctrine of reasonable doubt is not for application. 38 C.F.R. § 3.102. The claim is denied. Entitlement to service connection for a right shoulder disorder In March 2016, VA denied entitlement to service connection for a right shoulder disorder. The Veteran disagreed and perfected this appeal. Service treatment records show the Veteran was seen in March 1990 with complaints of right shoulder pain after trying to spike a volleyball the week prior. X-ray of the shoulder was reported as grossly normal and assessment following examination was “M-S shoulder strain”. No further complaints were noted and on examination for separation in December 1997, the upper extremities were reported as normal. In July 2015, Dr. Q. indicated that the Veteran had cervical spine pain radiating to his shoulders. The examiner did not provide a specific diagnosis related to the right shoulder but stated that the Veteran’s severe musculoskeletal diseases were more probable than not secondary to his military service. On VA examination in December 2016, the Veteran reported constant right shoulder pain which became worse with overhead activities. The diagnosis was listed as rotator cuff tendonitis. The examiner stated there was evidence of arthritis in both shoulders; however, the bilateral shoulder x-ray taken at that time was reported as normal. The examiner opined that the claimed condition was less likely than not caused by the in-service injury. The examiner noted there was evidence of a right shoulder musculoskeletal strain after the Veteran injured his right shoulder playing volleyball. Since then, military and VA records were silent for the condition at least within five years after being released from active duty. The examiner stated that this meant that the in-service right shoulder strain was acute and transitory which improved with proper treatment. The current condition was diagnosed 15 years after service and there is no evidence that he required treatment for this condition soon after being released from service. On review, there is no evidence of a chronic right shoulder disorder during service or for many years thereafter, and there is no evidence of right shoulder arthritis manifested to a compensable degree within one year following discharge from service. The VA opinion was based on examination of the Veteran and review of the record and it is probative. The July 2015 private statement from Dr. Q does not include a specific right shoulder diagnosis or any rationale, and there is no indication the physician reviewed the service treatment records. Hence, this statement is insufficient to outweigh the well-reasoned VA opinion of record. See Nieves-Rodriguez; Prejean. The preponderance of the evidence is against the claim and the doctrine of reasonable doubt is not for application. 38 C.F.R. § 3.102. The claim is denied.   Entitlement to service connection for a cervical spine disorder In March 2016, VA denied entitlement to service connection for a cervical spine disorder. The Veteran disagreed and perfected this appeal. Service treatment records show the neck was examined in connection with a March 1990 right shoulder injury. A specific neck injury was not noted and a diagnosis related to the neck was not provided. A neck disorder was not noted on separation examination in December 1997. An April 2015 private neurologic evaluation notes the Veteran had low back pain since 1997, but his neck pain was of a more recent origin. Diagnosis included chronic cervical strain. A July 2015 statement from Dr. Q. includes diagnoses of chronic cervical spine pain and chronic myositis para-cervical spine muscles. The physician also stated that the Veteran’s musculoskeletal diseases were more probable than not secondary to his military service performance. The Veteran underwent a VA cervical spine examination in February 2016. X-rays at that time showed cervical degenerative disc disease with spondylosis and diagnoses were listed as degenerative arthritis and intervertebral disc syndrome. The examiner opined that the condition was less likely than not related to service. He noted that the Veteran was diagnosed with musculoskeletal right shoulder strain; but that the service treatment records were silent for a neck condition and military and VA records were silent for at least 5 years after discharge. Additionally, it was very known in medical literature that cervical degenerative disc disease with spondylosis was considered part of the normal aging process in patient’s older than 40. As set forth, there is no evidence of a chronic neck disorder during service or for many years thereafter. On review, the VA opinion is based on review of the records and physical examination and it is considered probative. The July 2015 private statement does not include any rationale or any indication service treatment records were reviewed, and it is not sufficient to outweigh the well-reasoned VA opinion of record. Nieves-Rodriguez; Prejean. There is also no evidence of cervical spine arthritis manifested to a compensable degree within one year following discharge from service. The preponderance of the evidence is against the claim and the doctrine of reasonable doubt is not for application. 38 C.F.R. § 3.102. The claim is denied. Entitlement to service connection for right and left ankle disorders In March 2016, VA denied entitlement to service connection for right and left ankle disorders. The Veteran disagreed and perfected this appeal. Service treatment records are negative for complaints or findings related to the ankles. On separation examination in December 1997, the Veteran’s lower extremities were reported as normal on clinical evaluation. A July 2015 statement from Dr. Q. indicates the Veteran experiences various symptoms radiating to his ankles. The physician further states that the Veteran’s musculoskeletal diseases are more probable than not secondary to his military service performance. On review, there is no evidence of any chronic ankle disorders during service or for years thereafter. The Board acknowledges Dr. Q.’s statement but finds that it is not probative on this issue because it fails to specifically identify any ankle diagnosis and provides only a generic nexus opinion as to musculoskeletal disease without any rationale or indication that the service records were reviewed. The record simply does not contain any probative evidence showing currently diagnosed disorders of the right and/or left ankle related to active service or events therein. There is also no evidence of ankle arthritis manifested to a compensable degree within one year following discharge from service. The preponderance of the evidence is against the claims and the doctrine of reasonable doubt is not for application. 38 C.F.R. § 3.102. The claim is denied.   Entitlement to service connection for left ear hearing loss In March 2016, VA denied entitlement to service connection for left ear hearing loss. The Veteran disagreed with the decision and perfected this appeal. For VA purposes, impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, 4000 Hertz is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. Service treatment records do not show a left ear hearing loss disability for VA purposes. A July 2015 statement from Dr. Q. indicates the Veteran suffers from bilateral deafness. The physician did not supply any audiometric results and his statement standing alone is not sufficient to establish a current left ear hearing loss disability under 38 C.F.R. § 3.385. The Veteran underwent a VA hearing loss examination in February 2016. Audiometric testing of the left ear showed puretone thresholds at 500, 1000, 2000, 3000 and 4000 Hertz as follows: 20, 15, 15, 35, and 35. Speech discrimination score on the left was 100 percent. On review, objective evidence does not show a current left ear hearing loss disability for VA purposes. 38 C.F.R. § 3.385. Accordingly, service connection may not be granted. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). The preponderance of the evidence is against the claim and the doctrine of reasonable doubt is not for application. 38 C.F.R. § 3.102. The claim is denied.   Increased Ratings Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (rating schedule), found in 38 C.F.R. Part 4. Disability ratings are intended to compensate impairment in earning capacity due to a service-connected disorder. 38 U.S.C. § 1155. Right ear hearing loss In March 2016, VA granted entitlement to service connection for right ear hearing loss and assigned a noncompensable rating. The Veteran disagreed and perfected this appeal. A rating for hearing loss is determined by a mechanical application of the rating schedule to the numeric designations assigned based on audiometric test results. Lendenmann v. Principi, 3 Vet. App. 345 (1992). Evaluations of defective hearing range from noncompensable to 100 percent. The basic method of rating hearing loss involves audiological test results of organic impairment of hearing acuity as measured by the results of controlled speech discrimination tests (Maryland CNC), together with the average hearing threshold level as measured by puretone audiometry tests in the frequencies of 1000, 2000, 3000, and 4000 Hertz. Puretone threshold average is the sum of puretone thresholds at 1000, 2000, 3000, and 4000 Hertz divided by four. To evaluate the degree of disability of service-connected hearing loss, the rating schedule establishes eleven auditory acuity levels ranging from numeric level I for essentially normal acuity, through numeric level XI for profound deafness. 38 C.F.R. § 4.85, Diagnostic Code 6100. The current rating criteria include an alternate method of rating exceptional patterns of hearing as defined in 38 C.F.R. § 4.86 (puretone threshold of 55 decibels or more at 1000, 2000, 3000, and 4000 Hertz; puretone threshold of 30 decibels or less at 1000 Hertz and 70 decibels or more at 2000 Hertz). If impaired hearing is service-connected in only one ear, in order to determine the percentage evaluation from Table VII, the nonservice-connected ear is assigned a Roman Numeral designation for hearing impairment of I subject to the provisions of § 3.383 of this chapter. 38 C.F.R. § 4.85(f). The Veteran underwent VA audiometric testing in February 2016. The examiner stated that the Veteran’s voluntary responses were very inconsistent and he tended to exaggerate. The appellant was reinstructed several times until the examiner was able to secure valid test results for rating purposes. Puretone thresholds at 1000, 2000, 3000 and 4000 Hertz in the right ear were 15, 15, 35, and 40 respectively. Puretone threshold average was 26. Speech discrimination testing was 100 percent in the right ear. An exceptional pattern of hearing impairment was not shown. Considering the above findings, the Veteran has a level I hearing loss on the right. The paired organ rule is not for application and the nonservice-connected left ear is also assigned a Roman Numeral I. This corresponds to a noncompensable rating. There is no basis for assigning a higher rating and the claim is denied. Nephrolithiasis In March 2016, VA increased the rating for nephrolithiasis to 30 percent effective August 26, 2015. The Veteran disagreed with the rating and perfected this appeal. Nephrolithiasis is rated as hydronephrosis, except that a 30 percent rating is assigned when there is recurrent stone formation requiring one or more of the following: (1) diet therapy; (2) drug therapy; (3) invasive or non-invasive procedures more than two times per year. 38 C.F.R. § 4.115b, Diagnostic Code 7508. A 30 percent rating is assigned for hydronephrosis when there are frequent attacks of colic with infection (pyonephrosis), kidney function impaired. 38 C.F.R. § 4.115b, Diagnostic Code 7509. When the condition is severe, it is rated as renal dysfunction. Id. Renal dysfunction with albumin constant or recurring with hyaline and granular casts or red blood cells; or, transient or slight edema or hypertension that is at least 10 percent disabling under Diagnostic Code 7101 warrants a 30 percent evaluation. Renal dysfunction with constant albuminuria with some edema; or, definite decrease in kidney function; or, hypertension at least 40 percent disabling under Diagnostic Code 7101 warrants a 60 percent rating. Renal dysfunction with persistent edema and albuminuria with BUN 40 to 80mg% or creatinine 4 to 8mg% or generalized poor health characterized by lethargy, weakness, anorexia, weight loss or limitation of exertion warrants an 80 percent rating. Renal dysfunction requiring regular dialysis or precluding more than sedentary activity from one of the following: persistent edema and albuminuria; or BUN more than 80mg% or creatinine more than 8mg% or markedly decreased function of kidney or other organ systems especially cardiovascular warrants a 100 percent rating. 38 C.F.R. § 4.115a. A November 2015 abdominopelvic computed tomography (CT) scan showed tiny high attenuation densities at both kidneys without hydronephrosis suggestive of tiny nephrolithiasis. At a February 2016 VA examination, the Veteran reported recurrent renal colic and passing of stones. He reported visiting private emergency rooms at least five times during the last year and was treated with intravenous fluids and pain medications. He denied a history of surgeries or invasive procedures during the last five years. The Veteran did not take continuous medication but he was on diet therapy consisting of high fluid intake and low sodium. He experienced frequent attacks of colic but did not have recurrent symptomatic urinary tract or kidney infections. The examiner indicated that there was no renal dysfunction. Laboratory studies (BUN, creatinine, and EGFR) were normal. Urinalysis was also normal without hyaline or granular casts. On review, there is no evidence of renal dysfunction and the criteria for a rating greater than 30 percent are not met or more nearly approximated. The claim is denied. REASONS FOR REMAND As to all issues remanded, updated VA medical records should be obtained. 38 C.F.R. § 3.159(c)(2). Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder, anxiety, and depression In March 2016, VA denied entitlement to service connection for posttraumatic stress disorder, anxiety and depression. The Veteran disagreed and perfected this appeal. The Board has rephrased the issue to reflect consideration of any acquired psychiatric disorder. Clemons v. Shinseki, 23 Vet. App. 1 (2009). Various records suggest that the Veteran has depression related to his medical conditions, to include service-connected disorders. For example, a September 2003 psychiatric evaluation indicates the causes for his psychiatric profile were his current state of health and the disabling consequences of same. A June 2005 psychiatric evaluation includes a diagnosis of major depressive disorder, severe recurrent, with psychotic features due to general medical condition. A February 2011 evaluation notes recurrent severe major depression exacerbated by his back condition. In a July 2015 statement, Dr. Q. provided diagnoses of generalized anxiety disorder, major depression disease, and posttraumatic stress disorder. He further indicated that the psychiatric disorders were “more probable” (sic) than not secondary to service. In October 2015, the Veteran submitted a statement reporting several stressors to include being assaulted during advanced infantry training at Fort Dix in 1988, and suffering a fall in 1996 while marching. He alleged that the fall led to a profile and him being removed from his position as a squad leader. He also reported fear related to his service in Germany during the Persian Gulf War when he had to check vehicles for explosive devices. On review, a VA examination and opinion are needed to determine whether the Veteran has any acquired psychiatric disorder related to service or service-connected disability. 38 C.F.R. § 3.159(c)(4). Right hip disorder VA most recently denied service connection for a right hip disorder because new and material evidence had not been submitted. The November 2016 statement of the case specifically states that the claim for a right hip condition remains denied because the evidence submitted was not new and material. The above decision reopens the claim. Accordingly, a remand is necessary for the RO to consider the claim on the merits. Hickson v. Shinseki, 23 Vet. App. 394 (2010). Heart disorder In March 2016, VA denied entitlement to service connection for a heart disorder. The Veteran disagreed and perfected this appeal. Service treatment records are negative for any complaints or findings related to the heart and there is no evidence of a heart disorder for many years following discharge. Notwithstanding, a July 2015 statement from the Veteran’s private physician includes a diagnosis of hypertensive cardiovascular disease and indicates that his cardiovascular disease is “more probable” than not secondary to military service. Considering this statement, the Board finds that a VA examination and opinion is warranted. 38 C.F.R. § 3.159(c)(4). Increased rating for lumbar paravertebral myositis In March 2016, VA increased the rating for lumbar paravertebral myositis to 40 percent from August 26, 2015. The Veteran disagreed with the rating and perfected this appeal. The Veteran underwent a VA thoracolumbar examination in February 2016. Regarding whether pain, weakness, fatigability or incoordination significantly limited functional ability with repeated use over a period of time or with flare-ups, the examiner stated that it was not possible to answer without resorting to mere speculation because no positive flare-up episodes were observed during the evaluation. In Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Court held that examiners must offer opinions with respect to the additional limitation of motion during flare-ups based on estimates derived from information procured from relevant sources, including a Veteran’s lay statements. The Court explained that an examiner must do all that reasonably could be done in order to become informed before concluding that a requested opinion cannot be provided without resorting to speculation. In accordance with Sharp, the Veteran should be afforded a new examination. Additionally, the rating schedule indicates that associated neurologic abnormalities are to be separately evaluated. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine, Note (1). Both VA and private records suggest the Veteran’s experiences radicular symptoms in the lower extremities. The February 2016 VA examiner, however, indicated that the Veteran did not have radicular pain or any signs or symptoms of radiculopathy. Thus, additional information is needed as to whether the Veteran currently has any radiculopathy associated with his service-connected lumbar spine disorder. Increased rating for a left hip disorder In March 2016, VA granted entitlement to service connection for a left hip disorder and assigned a noncompensable rating. The Veteran disagreed and perfected this appeal. On review, it does not appear that the Veteran was provided a hip examination. A current examination is needed to determine the severity of this disorder. 38 C.F.R. § 3.327.   Individual unemployability This claim is inextricably intertwined with the issues remanded herein, Harris v. Derwinski, 2 Vet. App. 180, 183 (1991). Hence, adjudication is deferred pending completion of the requested development. The matters are REMANDED for the following action: 1. Obtain the Veteran’s VA treatment records for the period from March 2016 to the present. If the AOJ cannot locate any Federal records requested herein, it must specifically document the attempts that were made to locate them, and explain in writing why further attempts to locate or obtain any government records would be futile. The AOJ must then: (a) notify the claimant of the specific records that it is unable to obtain; (b) explain the efforts VA has made to obtain that evidence; and (c) describe any further action it will take with respect to the claim. The claimant must then be given an opportunity to respond. 2. Thereafter, schedule the Veteran for a VA psychiatric examination to determine the nature and etiology of any diagnosed acquired psychiatric disorder, to include posttraumatic stress disorder, anxiety, and/or depression. The Veteran’s VBMS and Virtual VA/Legacy folders must be available for review. The examiner must opine whether the evidence of record, including the Veteran’s October 2015 statement, corroborate the claim that a personal assault occurred in service (38 C.F.R. § 3.304(f)(5)). If the Veteran is diagnosed with posttraumatic stress disorder, the examiner must explain how the diagnostic criteria are met and opine whether it is at least as likely as not related to a corroborated in-service personal assault, or otherwise related to the Veteran’s fear of hostile military or terrorist activity. The examiner must also opine whether it is at least as likely as not that any other diagnosed psychiatric disorder, to include generalized anxiety and major depression, is related to an in-service injury, event, or disease. If no currently diagnosed psychiatric disorder is related to active service, the examiner must opine whether any diagnosed psychiatric disorder is at least as likely as not (a) proximately due to service-connected disability; or (b) aggravated beyond its natural progression by service-connected disability. A complete, well-reasoned rationale must be provided for any opinion offered. If the requested opinion cannot be rendered without resorting to speculation, the examiner must state whether the need to speculate is caused by a deficiency in the state of general medical knowledge, i.e., no one could respond given medical science and the known facts, or by a deficiency in the record or the examiner, i.e., additional facts are required, or the examiner does not have the needed knowledge or training. 3. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any diagnosed heart disorder. The Veteran’s VBMS and Virtual VA/Legacy folders must be available for review. For each and every diagnosed heart disorder, the examiner must opine whether it is at least as likely as not related to active service or events therein. A complete, well-reasoned rationale must be provided for any opinion offered. If the requested opinion cannot be rendered without resorting to speculation, the examiner must state whether the need to speculate is caused by a deficiency in the state of general medical knowledge, i.e., no one could respond given medical science and the known facts, or by a deficiency in the record or the examiner, i.e., additional facts are required, or the examiner does not have the needed knowledge or training. 4. Schedule the Veteran for an examination to determine the current severity of his lumbar paravertebral myositis. The examiner must attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. To the extent possible, the examiner should identify any symptoms and functional impairments due to lumbar paravertebral myositis alone and discuss the effect of lumbar paravertebral myositis on any occupational functioning and activities of daily living. If it is not possible to provide a specific measurement, or an opinion regarding flare-ups, symptoms, or functional impairment without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). The examiner is also requested to state whether any lower extremity radiculopathy is at least as likely as not related to lumbar paravertebral myositis. 5. Schedule the Veteran for an examination to determine the current severity of his left hip disorder. The examiner must attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. To the extent possible, the examiner should identify any symptoms and functional impairments due to the left hip disorder alone and discuss the effect of this disability on any occupational functioning and activities of daily living. Left hip motion must be tested actively and passively in weight-bearing and nonweight-bearing, and after repetitive use. The examiner is to report each tested range of motion measurement in degrees. The examiner must address whether there is likely to be additional range of motion loss due to any of the following: (1) during flare-ups; and, (2) as a result of pain, weakness, fatigability, or incoordination. If so, the examiner must describe the additional loss, in degrees, if possible. If it is not possible to provide a specific measurement, or an opinion regarding flare-ups, symptoms, or functional impairment without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training).   6. Adjudicate the claim of entitlement to service connection for a right hip disorder on the merits. DEREK R. BROWN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Carsten, Counsel