Citation Nr: 18158093 Decision Date: 12/18/18 Archive Date: 12/14/18 DOCKET NO. 16-57 081 DATE: December 18, 2018 ORDER Entitlement to a rating greater than 20 percent for lumbar spine stenosis with degenerative disc disease is denied. Restoration of the 10 percent evaluation for service-connected pulmonary nodule, effective May 15, 2014, is granted Entitlement to a temporary total evaluation for hospitalization in excess of 21 days is denied. REMANDED Entitlement to a rating greater than 10 percent for pulmonary nodule is remanded. Entitlement to a compensable disability evaluation for pseudofolliculitis barbae is remanded. Entitlement to a total disability rating on the basis of individual unemployability (TDIU) is remanded. FINDINGS OF FACT 1. The Veteran’s lumbar spine stenosis with degenerative disc disease is manifest by pain, without spasm, abnormal gait, or spinal contour. Forward flexion is limited to 60 degrees; the Veteran does not experience incapacitating episodes. 2. The RO’s decision to reduce the Veteran’s evaluation for service-connected pulmonary nodule from 10 percent to noncompensable as of May 15, 2014, was not supported by the evidence contained in the record at the time of the reduction. 3. The Veteran was not hospitalized in excess of 21 days for treatment or observation of a service-connected disability. CONCLUSIONS OF LAW 1. The criteria for a disability evaluation in excess of 20 percent for lumbar spine stenosis with degenerative disc disease have not been met. 38 U.S.C. §§ 1155, 5103A, 5107(b); 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.2, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5235 to 5243 (2018). 2. The reduction of the disability evaluation for the Veteran’s service-connected pulmonary nodule from 10 percent to noncompensable was not proper, and the 10 percent disability evaluation is restored from May 15, 2014. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.105, 3.344, 4.97, Diagnostic Code 6845 (2018). 3. The criteria for a temporary total disability rating under 38 C.F.R. § 4.29 for hospitalization in excess of 21 days have not been met. 38 U.S.C. §§ 1155; 38 C.F.R. §§ 3.102, 4.29 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the U.S. Navy from September 1983 to September 1987. These matters come before the Board of Veterans’ Appeals (Board) on appeal from a September 2014 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Atlanta, Georgia. The Board observes that the issue of the propriety of the reduction of the Veteran’s evaluation for his service-connected pulmonary nodule originated from a claim for an increased disability rating for his service-connected pulmonary nodule. As will be explained below, the Veteran’s 10 percent disability rating is being restored, but whether the Veteran is entitled to a disability rating in excess of 10 percent must be addressed by the RO. Duties to Notify and Assist The Veterans Claims Assistance Act of 2000 (VCAA) imposes obligations on VA to provide claimants with notice and assistance. 38 U.S.C. §§ 5102, 5103, 5103A, 5107, 5126; Honoring America’s Veterans and Caring for Camp Lejeune Families Act of 2012, Pub. L. No. 112-154, §§ 504, 505, 126 Stat. 1165, 1191-93; 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2018). The VCAA requires VA to assist a claimant at the time that he or she files a claim for benefits. As part of this assistance, VA is required to notify claimants of the evidence that is necessary in substantiating their claims, and provide notice that a disability rating and an effective date for the award of benefits will be assigned if service connection is awarded. 38 U.S.C. § 5103(a); 38 C.F.R. § 3.159(b)(1); Quartuccio v. Principi, 16 Vet. App. 183, 187 (2002); Dingess v. Nicholson, 19 Vet. App. 473, 486 (2006). In this case, the agency of original jurisdiction (AOJ) issued a notice letter to the Veteran. The letter explained the evidence necessary to substantiate the Veteran’s claims for increased disability ratings, as well as the legal criteria for entitlement to such benefits. The letter also informed him of his and VA’s respective duties for obtaining evidence. The AOJ decision that is the basis of this appeal was decided after the issuance of an initial, appropriate VCAA notice. As such, there was no defect with respect to timing of the VCAA notice. See Pelegrini v. Principi, 18 Vet. App. 112 (2004). Regarding the Veteran’s claim for a temporary total disability evaluation, the United States Court of Appeals for Veterans Claims (Court) has held that where the law, and not the underlying facts or development of the facts are dispositive in a matter, the duty to notify and assist can have no effect on the appeal. See Manning v. Principi, 16 Vet. App. 534, 542 (2002). See also Smith v. Gober, 14 Vet. App. 227 (2002) (VCAA has no effect on appeal limited to interpretation of law); Dela Cruz v. Principi, 15 Vet. App. 143 (2001) (VCAA not applicable where law, not factual evidence, is dispositive). VA also has a duty to assist a veteran with the development of facts pertinent to the appeal. 38 U.S.C. § 5103A; 38 C.F.R. § 3.159(c). This duty includes the obtaining of “relevant” records in the custody of a Federal department or agency under 38 C.F.R. § 3.159(c)(2), as well as records not in Federal custody (e.g., private medical records) under 38 C.F.R. § 3.159(c)(1). VA will also provide a medical examination if such examination is determined to be “necessary” to decide the claim. 38 C.F.R. § 3.159(c)(4). The claims file contains the Veteran’s available service treatment records, reports of post-service treatment, and the Veteran’s own statements in support of his claims. The Veteran was afforded VA examinations responsive to the claims for increased disability evaluations. The opinions were conducted by a medical professional, following thorough examination of the Veteran, solicitation of history, and review of the claims file. The examination reports contain all the findings needed to assess the Veteran’s service-connected disabilities on appeal, including history and clinical evaluation. See 38 C.F.R. § 3.327(a) (2018); Palczewski v. Nicholson, 21 Vet. App. 174, 182-83 (2007). The claims file contains the Veteran’s available service treatment records, reports of post-service treatment, and the Veteran’s own statements in support of his claims. The Board has reviewed the Veteran’s statements and medical evidence of record and concludes that there is no outstanding evidence with respect to the Veteran’s claims. For these reasons, the Board finds that the VCAA duties to notify and assist have been met. Increased Rating Disability evaluations are determined by application of the criteria set forth in the VA’s Schedule for Rating Disabilities, which is based on average impairment in earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. An evaluation of the level of disability present must also include consideration of the functional impairment of the Veteran's ability to engage in ordinary activities, including employment. 38 C.F.R. § 4.10. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 38 C.F.R. § 4.3. Separate evaluations may be assigned for separate periods of time based on the facts found. In other words, the evaluations may be staged. Staged ratings are appropriate for any rating claim when the factual findings show distinct time periods during the appeal period where the service-connected disability exhibits symptoms that would warrant different ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Here, the service-connected disability on appeal has not materially changed and a uniform evaluation is warranted for the rating period on appeal. In addition, when assessing the severity of a musculoskeletal disability that is rated on the basis of limitation of motion, VA must also consider the extent that the veteran may have additional functional impairment above and beyond the limitation of motion objectively demonstrated, such as during times when his symptoms are most prevalent (“flare-ups”) due to the extent of his pain (and painful motion), weakness, premature or excess fatigability, and incoordination. See DeLuca v. Brown, 8 Vet. App. 202, 204-7 (1995); see also 38 C.F.R. §§ 4.40, 4.45, 4.59. Entitlement to an increased disability evaluation for lumbar spine stenosis with degenerative disc disease, currently rated as 20 percent disabling The Veteran has been assigned a 20 percent disability rating for lumbar spine stenosis with degenerative disc disease pursuant to 38 C.F.R. § 4.71a, Diagnostic Code 5243. Lumbosacral and cervical spine disabilities are rated under the General Rating Formula for Rating Diseases and Injuries of the Spine (“general rating formula”). 38 C.F.R. § 4.71a, Diagnostic Code 5237-5243. Intervertebral disc syndrome (IVDS) is rated under the general rating formula or the Formula for Rating IVDS Based on Incapacitating Episodes, whichever method results in the higher rating when all disabilities are combined under 38 C.F.R. § 4.25. See 38 C.F.R. § 4.71a, Diagnostic Code 5243. For VA compensation purposes, unfavorable ankylosis is a condition in which the entire cervical spine, entire thoracolumbar spine, or entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. 68 Fed. Reg. 51,443, Note (5) (Aug. 27, 2003). The Formula for Rating IVDS Based on Incapacitating Episodes provides for ratings from 10 to 60 percent based on the frequency and duration of incapacitating episodes, defined in Note 1 as a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician. The maximum 60 percent schedular rating is warranted for incapacitating episodes having a total duration of at least 6 weeks during the previous 12 months. The Notes following the General Rating Formula for Diseases and Injuries of the Spine provide further guidance in rating diseases or injuries of the spine. Note 1 provides that any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, should be rated separately under an appropriate diagnostic code. Note 2 provides that, for VA compensation purposes, the combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined range of motion of the cervical spine is 340 degrees and of the thoracolumbar spine is 240 degrees. Note 4 provides that range of motion measurements are to be rounded to the nearest five degrees. Note 5 defines unfavorable ankylosis as a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. Note 6 provides that disability of the thoracolumbar and cervical spine segments are to be rated separately, except when there is unfavorable ankylosis of both segments, which will be rated as a single disability. According to the general rating formula, a 10 percent evaluation is to be assigned for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or combined range of motion of the thoracolumbar spine greater than 120 degrees, but not greater than 235 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height. A 20 percent evaluation is to be assigned for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 40 percent evaluation is to be assigned for forward flexion of the thoracolumbar spine 30 degrees or less; or favorable ankylosis of the entire thoracolumbar spine. A 50 percent evaluation is to be assigned for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent evaluation is to be assigned for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, Diagnostic Code 5237 for lumbosacral strain; Diagnostic Code 5242 for degenerative arthritis of the spine; and Diagnostic Code 5243 for intervertebral disc syndrome. After a review of all the evidence, the Board finds that the Veteran’s disability picture more nearly approximates the criteria for the currently assigned initial 20 percent disability rating for the rating period on appeal. The Board notes that the Veteran’s December 2016 and October 2017 VA examinations and VA and private treatment records for the rating period on appeal do not reflect that the Veteran has intervertebral disc syndrome. Regardless, the VA examiners indicated that the Veteran does not have any incapacitating episodes as a result of his lumbar spine stenosis with degenerative disc disease. Thus, even if intervertebral disc syndrome was present, it would not be compensable. At the February 2014 VA examination, the Veteran had forward flexion to 90 degrees, extension to 30 degrees, right and left lateral flexion to 30 degrees per side, and right and left lateral rotation to 25 degrees, respectively. At the May 2015 VA examination, the Veteran had forward flexion to 90 degrees, extension to 20 degrees, right and left lateral flexion to 30 degrees per side, and right and left lateral rotation to 30 degrees per side. At the December 2016 VA examination, the Veteran had forward flexion to 65 degrees, extension to 20 degrees, right and left lateral flexion to 25 degrees per side, and right and left lateral rotation to 20 degrees per side. Most recently, at the October 2017 VA examination, the Veteran had forward flexion to 60 degrees, extension to 20 degrees, right lateral flexion to 20 degrees, left lateral flexion to 15 degrees per side, and right and left lateral rotation to 15 degrees per side. Examination reports and treatment records indicate that the Veteran experienced decreased or abnormal range of motion, pain on motion, without tenderness to palpation, muscle spasm, abnormal gait, or spinal contour. The VA examination reports and treatment records indicate that there was pain on motion, without guarding, weakness, or atrophy; strength and reflex testing was normal. There was no evidence of postural abnormalities or abnormalities of the musculature of the spine. Thus, applying the facts to the criteria set forth above, the Veteran is entitled to a 20 percent evaluation for his service-connected lumbar spine stenosis with degenerative disc disease for the entire rating period on appeal under the General Rating Formula for Diseases and Injuries of the Spine. The Board finds that the criteria for a disability rating of 40 percent have not been met or more nearly approximated for any part of the rating period on appeal. The evidence shows that the Veteran experiences forward flexion of the thoracolumbar spine which is greater than 30 degrees. Here, the lay evidence has been considered; however, that evidence when accepted as correct does not establish that he is functionally limited to 30 degrees or less of forward flexion. He does not experience incontinence or bowel complaints as a result of his lumbar spine stenosis with degenerative disc disease. Further, the evidence does not show favorable or unfavorable ankylosis of the entire thoracolumbar spine during the rating period on appeal. The Board has considered whether additional functional impairment due to factors such as pain, weakness and fatigability demonstrate additional limitation of motion or function to warrant a higher rating. See 38 C.F.R. §§ 4.40, 4.45, 4.59 and DeLuca at 206-07. To the extent that the Veteran claims that his pain upon motion is the equivalent of limited motion, the Board finds that the Veteran’s subjective complaints of pain have been contemplated in the current rating assignment, as the current rating is based on the objectively demonstrated limited reduced motion; the VA examination reports indicate that the Veteran complained of pain, but physical examination did not demonstrate any additional limitations in response to pain, including incoordination, weakness, or fatigability, beyond which was reflected in the examination reports. See Mitchell v. Shinseki. Therefore, the lay and medical evidence demonstrates that the Veteran’s symptoms do not result in additional functional limitation to a degree that would support a rating in excess of the current 20 percent disability rating. As noted earlier, the Veteran’s lumbar spine stenosis with degenerative disc disease has not been productive of incapacitating episodes for the rating period on appeal. The Veteran has not reported, and the evidence does not demonstrate, that the Veteran experiences incapacitating episodes requiring bed rest; the Veteran’s treatment records do not confirm that his treating physicians noted any incapacitating episodes or prescribed bed rest, and the Veteran’s VA examination reports reflect that the Veteran has not experienced any incapacitating episodes requiring bed rest. With respect to a higher evaluation based on incapacitating episodes under the Formula for Rating Intervertebral Disc Syndrome (IVDS) Based on Incapacitating Episodes, the record does not show that the Veteran experiences incapacitating episodes requiring physician prescribed best rest having a total duration of at least 4 weeks during a 12-month period as contemplated by a higher evaluation. Review of the Veteran’s treatments record also do not reveal any periods of physician prescribed bed rest as a result of his lumbar spine stenosis with degenerative disc disease. With consideration of the provisions of Note (1) of the General Rating Formula for Diseases and Injuries of the Spine, the Veteran was granted service connection for radiculopathy of the right and left lower extremities and assigned separate disability evaluations. As the Veteran is separately evaluated for his lower extremity neurological deficits, it is not for consideration here. As such, the Board finds that the Veteran is not entitled to a disability rating in excess of 20 percent for service-connected lumbar spine stenosis with degenerative disc disease. Reduction In certain rating reduction cases, VA benefits recipients are to be afforded greater protections, set forth in 38 C.F.R. § 3.344(a), (b). Those sections provide that rating agencies will handle cases affected by change of medical findings or diagnosis, so as to produce the greatest degree of stability of disability evaluations consistent with the laws and VA regulations governing disability compensation and pension. However, the provisions of 38 C.F.R. § 3.344(c) specify that those considerations are required for ratings which have continued for long periods at the same level (five years or more), and that they do not apply to disabilities which have not become stabilized and are likely to improve. Reexaminations disclosing improvement, physical or mental, in these disabilities will warrant a reduction in rating. When a veteran’s disability rating is reduced by a RO without following the applicable regulation, the reduction is void ab initio. See Greyzk v. West, 12 Vet. App. 288, 292 (1999). Thus, to remedy such cases, the decision must be reversed as unlawful. Dofflemyer v. Derwinski, 2 Vet. App. 277 (1992). Under 38 C.F.R. § 3.344(a), (b) the RO must find the following: (1) based on a review of the entire record, the examination forming the basis for the reduction is full and complete, and at least as full and complete as the examination upon which the rating was originally based; (2) the record clearly reflects a finding of material improvement; and (3) it is reasonably certain that the material improvement found will be maintained under the ordinary conditions of life. Kitchens v. Brown, 7 Vet. App. 320 (1995); Brown, supra. In general, when there is an approximate balance of evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. However, the Court has specified a different burden of proof with respect to ratings reductions claims. Because the issue in this case is whether the RO was justified in reducing the Veteran’s rating, rather than whether the Veteran was entitled to “reinstatement” of the rating, the Board is required to establish, by a preponderance of evidence and in compliance with 38 C.F.R. § 3.344(a), that a rating reduction was warranted. See Brown, 5 Vet. App. at 420; see also Kitchens 7 Vet. App. at 325. Disability ratings are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities. Where there is a reasonable doubt as to the degree of disability, such doubt shall be resolved in favor of the claimant, and where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. 38 C.F.R. §§ 3.102, 4.3, 4.7. In addition, the Board will consider the potential application of the various other provisions of 38 C.F.R., Parts 3 and 4, whether or not they were raised by the veteran, as well as the entire history of the veteran’s disorder in reaching its decision, as required by Schafrath v. Derwinski, 1 Vet. App. 589 (1991). The Veteran’s pulmonary nodule was rated as 10 percent disabling pursuant to 38 U.S.C. § 4.97, Diagnostic Code 6845. Service connection was granted effective March 6, 2012, and the Veteran’s rating was reduced to noncompensable effective May 15, 2014. Therefore, the requirements pertaining to reductions of ratings that have been in effect for at least five years are not applicable. 38 C.F.R. § 3.344(a), (b). Pursuant to 38 C.F.R. § 3.344(c), an examination disclosing improvement will warrant reduction in the rating. 38 C.F.R. § 3.344(c). The question is thus whether an examination had shown an improvement warranting reduction in the rating. The Board notes that 38 C.F.R. § 4.96 provides that when applying Diagnostic Codes 6600, 6603, 6604, 6825-6833, and 6840-6845, pulmonary function tests are required except in certain circumstances specified in 38 C.F.R. § 4.96(d). The general rating formula for restrictive lung disease (Diagnostic Codes 6840 through 6845) warrants a 10 percent rating is warranted for chronic pleural effusion or fibrosis with FEV-1 of 71 to 80 percent predicted, or FEV-1/FVC of 71 to 80 percent, or DLCO (SB) of 66 to 80 percent predicted. A 30 percent rating is warranted for chronic pleural effusion or fibrosis with FEV-1 of 56-70 percent predicted, or FEV-1/FVC of 56 to 70 percent, or DLCO (SB) of 56 to 65 percent predicted. For a 60 percent rating, there must be chronic pleural effusion or fibrosis with FEV-1 of 40 to 55 percent predicted, or FEV-1/FVC of 40 to 55 percent, or DLCO (SB) of 40 to 55 percent predicted, or maximum oxygen consumption of 15 to 20 ml/kg/min (with cardiorespiratory limit). A 100 percent rating is available for FEV-1 of less than 40 percent predicted, or FEV-1/FVC of less than 40 percent, or DLCO (SB) less than 40 percent predicted; or maximum exercise capacity less than 15 ml/kg/min oxygen consumption (with cardiac or respiratory limitation); or cor pulmonale; or right ventricular hypertrophy; or pulmonary hypertension; or episodes of acute respiratory failure; or requires outpatient oxygen therapy. In this case, the Board finds that the evidence does not establish sustained improvement in the Veteran’s service-connected pulmonary nodule. The Board acknowledges that, based on the May 2014 VA examination, the RO may be correct in finding that the state of the Veteran’s pulmonary nodule did not meet the rating criteria for a 10 percent evaluation. See generally 38 C.F.R. § 4.97, Diagnostic Code 6845 (2018). The Board observes that the Veteran’s May 2014 pulmonary function tests revealed DLCO (SB) of 64 percent predicted pre-bronchodilator (post-bronchodilator was not recorded), FEV-1 of 99 percent predicted pre-bronchodilator and 100 percent predicted post-bronchodilator, and FEV-1/FVC of 82 percent pre- and post-bronchodilator. The Board acknowledges that the FEV-1/FVC results are just above the cutoff for a 10 percent disability evaluation. However, the available DLCO (SB) reading fell within the criteria for a 10 percent disability rating. Moreover, the objective evidence of record does not allow a conclusion that there had been a sustained improvement in the Veteran’s pulmonary nodule at the time of the May 2014 reduction, particularly in light of the Veteran’s continued complaints of worsening symptoms. Likewise, the Board notes that the Veteran does not bear the responsibility to demonstrate that he is entitled to retain the higher evaluations. See Brown 5 Vet. App. at 418. As such, the reduction of the 10 percent disability evaluation to noncompensable, effective May 15, 2014, was not proper and the requirements for restoration have been met. See 38 C.F.R. § 3.344. Temporary Total Evaluation A total disability rating (100 percent) will be assigned without regard to other provisions of the rating schedule when it is established that a service-connected disability has required hospital treatment in a VA or an approved hospital for a period in excess of 21 days or hospital observation at VA expense for a service-connected disability for a period in excess of 21 days. 38 C.F.R. § 4.29 (2018). Subject to the provisions of paragraphs (d), (e), and (f) of § 4.29, this increased rating will be effective the first day of continuous hospitalization and will be terminated effective the last day of the month of hospital discharge (regular discharge or release to non-bed care) or effective the last day of the month of termination of treatment or observation for the service-connected disability. 38 C.F.R. § 4.29(a). If a hospital admission was for disability not connected with service, and during such hospitalization, hospital treatment for a service-connected disability is instituted and continued for a period in excess of 21 days, the increase to a total rating will be granted from the first day of such treatment. If service connection for the disability under treatment is granted after hospital admission, the rating will be from the first day of hospitalization if otherwise in order. See 38 C.F.R. § 4.29(b). The assignment of a total disability rating on the basis of hospital treatment or observation will not preclude the assignment of a total disability rating otherwise in order under other provisions of the rating schedule, and consideration will be given to the propriety of such a rating in all instances and to the propriety of its continuance after discharge. Particular attention, with a view to proper rating under the rating schedule, is to be given to the claims of veterans discharged from hospital, regardless of length of hospitalization, with indications on the final summary of expected confinement to bed or house, or to inability to work with requirement of frequent care of physician or nurse at home. See 38 C.F.R. § 4.29(c). Entitlement to a temporary total evaluation for hospitalization in excess of 21 days Based on the evidence of record, the Board cannot find that the Veteran was admitted to an inpatient program for a service-connected disability because records fail to show any inpatient treatment for a service-connected disability. The Board acknowledges VA treatment records reflect that he underwent surgical treatment for his lumbar stenosis with degenerative disc disease on July 22, 2013. However, nothing in his claims file demonstrates that he received in-hospital treatment or observation for a service-connected disability for a period in excess of 21 days; there is nothing in the available records to reflect that the Veteran required hospitalization or observation for 21 days related to his surgery for his service-connected lumbar stenosis with degenerative disc disease. For these reasons, the Board finds that the preponderance of the evidence is against the assignment of a temporary total evaluation due to VA hospital treatment in excess of 21 days. Thus, the benefit-of-the doubt doctrine does not apply, and the claim must be denied. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). REASONS FOR REMAND 1. Entitlement to a rating greater than 10 percent for pulmonary nodule is remanded. 2. Entitlement to a compensable rating for pseudofolliculitis barbae is remanded. The Veteran asserts that the symptoms of his service-connected pseudofolliculitis barbae and pulmonary nodule are more severe than presently evaluated. The Board observes that Veteran has not been afforded VA examinations in connection with these disabilities since May 2014, immediately following his claims. As such, the Veteran must be provided with examinations which consider the current severity of his service-connected disabilities on appeal. See Green v. Derwinski, 1 Vet. App. 121, 124 (1991). See also Snuffer v. Gober, 10 Vet. App. 400, 403 (1997) (holding that the Veteran was entitled to a new examination after a two-year period between the last VA examination and the Veteran's contention that the pertinent disability had increased in severity). Furthermore, VA must make all necessary efforts to obtain relevant records in the possession of a Federal agency. See 38 U.S.C. § 5103A; 38 C.F.R. § 3.159. See also Bell v. Derwinski, 2 Vet. App. 611 (1992). All available VA treatment records for the claims on appeal should be associated with the Veteran’s claims file. 3. Entitlement to TDIU is remanded. The TDIU claim is part and parcel of an increased rating claim being referred to the RO, and vice versa. Rice v. Shinseki, 22 Vet. App. 447 (2009). Given that additional development is required as to the Veteran’s claims for increased disability ratings for his service-connected pseudofolliculitis barbae and pulmonary nodule, the Board finds that a decision on the remaining issue of entitlement to TDIU must be deferred to allow the RO the opportunity to evaluate the Veteran’s service-connected disabilities on appeal. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991); see also Tyrues v. Shinseki, 23 Vet. App. 166, 177 (2009) (en banc). The matters are REMANDED for the following action: 1. Contact the Veteran and request that he identify the names, addresses, and approximate dates of treatment for all VA and non-VA health care providers who have treated him for his service-connected disabilities on appeal. The Veteran should be requested to sign any necessary authorization for release of medical records to VA, and appropriate steps should be made to obtain any identified records. If any requested records are not available, or the search for any such records otherwise yields negative results, that fact must clearly be documented in the claims file. If the records are unavailable, notify the Veteran in accordance with 38 C.F.R. § 3.159. 2. After any additional records are associated with the claims file, the RO should schedule the Veteran for an appropriate VA examination to ascertain the current severity and manifestations of his service-connected pseudofolliculitis barbae. The claims file should be made available to the examiner for review in connection with the examination. Any indication that the Veteran’s complaints or other symptomatology are not in accord with the objective findings on examination should be directly addressed and discussed in the examination report. The VA examiner should provide a complete rationale for any opinions provided. 3. After any additional records are associated with the claims file, the RO should schedule the Veteran for an appropriate VA examination to ascertain the current severity and manifestations of his service-connected pulmonary nodule. The claims file should be made available to the examiner for review in connection with the examination. Any indication that the Veteran’s complaints or other symptomatology are not in accord with the objective findings on examination should be directly addressed and discussed in the examination report. The VA examiner should provide a complete rationale for any opinions provided. 4. The Veteran should be provided with a VA examination in order to obtain an opinion as to the impact of his service-connected disabilities on his ability to perform physical and mental tasks in a work-like setting, without regard to the Veteran’s age or the impact of any nonservice-connected disabilities. 5. After completing all indicated development, the RO should readjudicate the Veteran’s claims for increased disability ratings for service-connected pseudofolliculitis barbae and pulmonary nodule, as well as the claim of entitlement to TDIU. If any of the claims remain denied, the Veteran should be furnished with a supplemental statement of the case and afforded a reasonable opportunity for response. (Continued on the next page)   GAYLE STROMMEN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Hallie E. Brokowsky, Counsel