Citation Nr: 18158283 Decision Date: 12/14/18 Archive Date: 12/14/18 DOCKET NO. 16-56 376 DATE: December 14, 2018 ORDER Entitlement to service connection for cervical strain is denied. Entitlement to service connection for right ear hearing loss is denied. Entitlement to an initial compensable rating for left leg shin splints with calf muscular strain is denied. Entitlement to an initial rating in excess of 10 percent for right leg shin splints with calf muscular strain is denied. Entitlement to an initial compensable rating for headaches is denied. REMANDED Entitlement to an initial rating in excess of 50 percent for posttraumatic stress disorder (PTSD) is remanded. Entitlement to an initial rating in excess of 10 percent for chronic low back strain with degenerative disc disease is remanded. FINDINGS OF FACT 1. A cervical spine disability has not been present during the period of the claim. 2. The Veteran does not currently have a right ear hearing loss disability for VA purposes. 3. The Veteran’s left leg shin splints with calf muscular strain has been manifested by subjective complaints of pain with no limitation of motion. The condition does not involve slight knee or ankle disability. 4. The Veteran’s right leg shin splints with calf muscular strain has been manifested by subjective complaints of pain with evidence of pain on range of motion testing. The condition does not involve moderate knee or ankle disability. 5. The Veteran’s headache disability has been manifested by complaints of headache pain. It has not been manifested by characteristic prostrating attacks. CONCLUSIONS OF LAW 1. The criteria for service connection for a cervical spine disability have not been met. 38 U.S.C. §§ 1110, 5107 (2014); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2017). 2. The criteria for service connection for right ear hearing loss have not been met. 38 U.S.C. §§ 1110, 5107 (2014); 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.385 (2017). 3. The criteria for an initial compensable rating for left leg shin splints with calf muscular strain have not been met. 38 U.S.C. §§ 1155, 5107 (2014); 38 C.F.R. §§ 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5022, 5262 (2017). 4. The criteria for an initial rating in excess of 10 percent for right leg shin splints with calf muscular strain have not been met. 38 U.S.C. §§ 1155, 5107 (2014); 38 C.F.R. §§ 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5022, 5262 (2017). 5. The criteria for an initial compensable rating for headaches have not been met. 38 U.S.C. §§ 1155, 5107 (2014); 38 C.F.R. §§ 3.321, 4.124a, Diagnostic Code 8100 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 1996 to February 2002; on active duty for training (ACDUTRA) from October 2002 to April 2003 and from June 2006 to December 2006; and on active duty from February 2008 to February 2009 and from September 2010 to September 2011. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from February 2013 and April 2013 rating decisions issued by the Department of Veterans Affairs (VA) Regional Office (RO) located in Indianapolis, Indiana. Service Connection Service connection may be granted for disability resulting from personal injury suffered or disease contracted in line of duty in the active military, naval, or air service. 38 U.S.C. §§ 1110, 1131 (2014); 38 C.F.R. §§ 3.303, 3.304, 3.306 (2017). The term active military, naval, or air service includes: (1) active duty, (2) any period of ACDUTRA during which the individual concerned was disabled or died from a disease or injury incurred or aggravated in the line of duty, and (3) any period of inactive duty training (INACDUTRA) during which the individual concerned was disabled or died from an injury incurred or aggravated in the line of duty. 38 U.S.C. § 101(24); 38 C.F.R. § 3.6(a). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303(d) (2017). Service connection for certain chronic diseases, including arthritis and sensorineural hearing loss, may also be established on a presumptive basis by showing that such a disease manifested itself to a degree of 10 percent or more within one year from the date of separation from service. 38 U.S.C. §§ 1101, 1112, 1137 (2014); 38 C.F.R. §§ 3.307 (a)(3), 3.309(a) (2017). In such cases, the disease is presumed under the law to have had its onset in service even though there is no evidence of such disease during the period of service. 38 C.F.R. § 3.307 (a) (2017); see also Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). For the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. If chronicity in service is not established, a showing of continuity of symptoms after discharge is required to support the claim. 38 C.F.R. § 3.303(b). A claimant can establish continuity of symptomatology with competent evidence showing: (1) that a condition was noted during service; (2) post-service continuity of the same symptomatology; and (3) a nexus between a current disability and the post-service symptomatology. Savage v. Gober, 10 Vet. App. 488, 495-96 (1997); 38 C.F.R. § 3.303(b). The advantage of this evidentiary presumption does not extend to those who claim service connection based on a period of ACDUTRA or INACDUTRA. McManaway v. West, 13 Vet. App. 60, 67 (citing Paulson v. Brown, 7 Vet. App. at 469-70, for the proposition that, if a claim relates to a period of [ACDUTRA], a disability must have manifested itself during that period; otherwise, the period does not qualify as active military service and claimant does not achieve Veteran status for purposes of that claim ); Biggins v. Derwinski, 1 Vet. App. 474, 478 (1991); Smith v. Shinseki, 24 Vet. App. 40, 47 (2010). In addition to the criteria set forth above, service connection for impaired hearing is subject to the additional requirement of 38 C.F.R. § 3.385, which provides that impaired hearing will be considered to be a disability only if at least one of the thresholds for the frequencies of 500, 1000, 2000, 3000, or 4000 Hertz is 40 decibels or greater; the thresholds for at least three of the frequencies are greater than 25 decibels; or speech recognition scores using the Maryland CNC Test are less than 94 percent. See also Hensley v. Brown, 5 Vet. App. 155 (1993). The standard of proof to be applied in decisions on claims for VA benefits is set forth in 38 U.S.C. § 5107(b). Under that provision, VA 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(b) (2014); see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 1. Entitlement to service connection for cervical strain The Veteran asserts that service connection is warranted for a cervical spine disability. Service treatment records demonstrate treatment for a neck injury during active duty. Notably, in a July 2008 record, it was reported that the Veteran suffered a cervical strain while lifting weights. He was referred to physical therapy. In a subsequent July 2008 statement of medical examination and duty status, it was noted that the Veteran suffered a cervical stain and calf cramps. However, both conditions were determined to have resolved with physical therapy. It was concluded that the injury was not incurred in the line of duty. In so finding, it was determined that the Veteran injured himself performing exercises not duty related. The Veteran was provided a VA cervical spine conditions examination in October 2012. At that time, a history of cervical strain in 2008 was noted. Notwithstanding, the Veteran denied any ongoing pain symptoms associated with the neck. He indicated that any possible previous cervical strain injury had resolved. Diagnostic test findings were also unremarkable. The examiner further noted that there was no particular mention of neck or cervical spine symptoms in the post-service treatment records. He concluded that upon reviewing the claims file, he would agree that the Veteran’s cervical strain injury occurring in July 2008 was at least as likely as not incurred in or caused by lifting weights in service in July 2008. However, since the line of duty statement indicated that the injury did not occur in the line of duty, he the Veteran’s claimed cervical strain injury is not a result of his active duty service per review of service treatment records. The Veteran underwent a VA muscle examination in November 2012. Following evaluation, the examiner indicated that the Veteran did not have an injury to a muscle group of the neck. Analysis After carefully considering the record on appeal, the Board finds that the preponderance of the evidence is against the claim of service connection for a cervical spine disability. As noted herein, Congress specifically limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability. See 38 U.S.C. § 1110; see also Brammer v. Derwinski, 3 Vet. App. 223 (1992); Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998). Again, the Board has carefully reviewed the record on appeal and can find no objective clinical indication that the Veteran currently has a cervical spine disability. Moreover, subjectively, the Veteran has not alleged pain that causes functional impairment of earning capacity. Indeed, the Board observes that the Veteran did not provide any argument in support of the claim. While service treatment records show that the Veteran suffered a cervical injury during active duty, that an injury occurred during active duty is not enough to establish service connection. Rather, there must be a current disability resulting from the in-service injury. In this case, that has not been shown. The Veteran’s service treatment records indicate that the in-service cervical spine injury resolved with physical therapy. Subsequent service treatment records did not show treatment for or a diagnosis of a cervical spine disability. Further, the clinical evidence of record contains no indication that at any time following separation from military service has the Veteran been diagnosed with a cervical spine disability. As detailed herein, the Veteran was provided a VA neck examination in October 2012 at which time a history of cervical strain was assessed. However, the Veteran denied any ongoing pain symptoms associated with the neck and reported that any previous cervical strain injury had resolved. Moreover, diagnostic findings were unremarkable and the examiner did not identify any current cervical spine disability or residual of the in-service cervical spine disability. Similarly, in the Report of the November 2012 VA muscles examination, it was determined that the Veteran did not have a muscle disability involving the neck. In summary, the record on appeal contains no probative evidence that a cervical spine disability has been present at any time since the filing of the Veteran’s service connection claim. The law limits entitlement for service-related diseases and injuries to cases where the underlying in-service incident has resulted in a current disability. Degmetich v. Brown, 104 F.3d 1328 (Fed. Cir. 1997); Rabideau v. Derwinski, 2 Vet. App. 141 (1992). Absent any indication that the Veteran currently has a cervical spine disability, the Board finds that the preponderance of the evidence is against the claim. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 2. Entitlement to service connection for right ear hearing loss The Veteran asserts that service connection for right ear hearing loss is warranted. He contends that the condition is due to noise exposure during active service. Service treatment records are negative for a diagnosis of right ear hearing loss. However, the hearing conservation data obtained shows shifts in right ear hearing acuity and confirms noise exposure during active service. The post-service record on appeal shows that the Veteran underwent a VA audiological examination in October 2012. Audiometric testing conducted in connection with that examination showed pure tone thresholds, in decibels, as follows:   HERTZ 500 1000 2000 3000 4000 RIGHT 0 5 10 20 15 Speech recognition was 96 percent in the right ear. The examiner diagnosed normal right ear hearing acuity. Analysis After carefully considering the record on appeal, the Board finds that the preponderance of the evidence is against the claim of service connection for right ear hearing loss. The Board acknowledges the notation of in-service noise exposure. These facts alone, however, do not provide a sufficient basis upon which to grant the claim. As discussed above, that an injury such as acoustic trauma occurred during active service is not enough to establish service connection. Rather, there must be a current disability resulting from the in-service injury. Here, in order to constitute a disability, impaired hearing must meet the criteria set forth at 38 C.F.R. § 3.385, a provision which specifically defines the level of impaired hearing which constitutes a disability for VA compensation purposes. In this case, the Board has carefully reviewed the record on appeal, but finds no probative evidence showing that the Veteran currently has right ear hearing loss to the extent necessary to constitute a disability for service connection purposes under 38 C.F.R. 3.385. Nor has the Veteran pointed to any such evidence. Congress specifically limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability. See 38 U.S.C. §§ 1110, 1131; see also Brammer v. Derwinski, 3 Vet. App. 223 (1992); Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998) (holding VA’s interpretation of the provisions of 38 U.S.C. § 1110 to require evidence of a present disability to be consistent with congressional intent); Rabideau v. Derwinski, 2 Vet. App. 141 (1992) (the law limits entitlement for service-related diseases and injuries to cases where the underlying in-service incident has resulted in a disability). In other words, the law limits entitlement to compensation to cases where the underlying in-service incident has resulted in a current disability. Degmetich v. Brown, 104 F.3d 1328 (Fed. Cir. 1997). In this case, the numeric designations shown on audiometric testing and speech recognition tests indicate that the Veteran’s hearing acuity is not severe enough to constitute a disability for VA compensation purposes. As the preponderance of the evidence is against the claim of service connection for right ear hearing loss, the benefit of the doubt doctrine is not for application. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Increased Rating Disability evaluations are determined by comparing a Veteran’s present symptomatology with criteria set forth in VA’s Schedule for Rating Disabilities (Rating Schedule), which is based on average impairment in earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Where a claimant appeals the initial rating assigned for a disability when a claim for service connection for that disability has been granted, evidence contemporaneous with the claim for service connection and with the rating decision granting service connection would be most probative of the degree of disability existing at the time that the initial rating was assigned and should be the evidence “used to decide whether an [initial] rating on appeal was erroneous...” Fenderson v. West, 12 Vet. App. 119, 126 (1999). If later evidence obtained during the appeal period indicates that the degree of disability increased or decreased following the assignment of the initial rating, “staged” ratings may be assigned for separate periods of time based on facts found. Id. For disabilities evaluated on the basis of limitation of motion, VA is required to apply the provisions of 38 C.F.R. §§ 4.40, 4.45, pertaining to functional impairment. The Court has instructed that in applying these regulations VA should obtain examinations in which the examiner determined whether the disability was manifested by weakened movement, excess fatigability, incoordination, or pain. Such inquiry is not to be limited to muscles or nerves. These determinations are, if feasible, to be expressed in terms of the degree of additional range-of-motion loss due to any weakened movement, excess fatigability, incoordination, flare-ups, or pain. DeLuca v. Brown, 8 Vet. App. 202 (1995); 38 C.F.R. § 4.59 (2017). Pain without accompanying functional limitation cannot serve as the basis for a higher rating. Mitchell v. Shinseki, 25 Vet. App. 32, 33, 43 (2011). It is, however, VA’s policy to grant at least the minimal compensable rating for actually painful motion. 38 C.F.R. § 4.59. When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). 3. Entitlement to an initial compensable rating for left leg shin splints with calf muscular strain. Entitlement to an initial rating in excess of 10 percent for right leg shin splints with calf muscular strain The Veteran’s service-connected left and right leg shin splints have been rated under Diagnostic Code 5022 for periostitis and Diagnostic Code 5262, which contemplates impairment of the tibia and fibula. With regards to Diagnostic Code 5022, the applicable rating criteria provides that diseases under Diagnostic Codes 5013-5024 will be rated on limitation of motion of the affected parts, as degenerative arthritis. 38 C.F.R. § 4.71a. Under Diagnostic Code 5262, a 10 percent rating is assigned with evidence of malunion of the tibia and fibula with slight knee or ankle instability. A 20 percent rating is warranted with a moderate knee or ankle disability. A 30 percent rating is warranted with a marked knee or ankle disability. A 40 percent rating is warranted with evidence of nonunion of the tibia and fibula, with loose motion, requiring a brace. 38 C.F.R. § 4.71a, Diagnostic Code 5262 (2017). Factual Background The Veteran was provided a VA knee and lower leg conditions examination in October 2012. At the time of the examination, the Veteran denied any recurrent ongoing problems with his lower legs, to include functional limitation. Additionally, no ongoing pain or dismobility was noted. The Veteran reported that he tried to stay active but avoided significant repetitive strenuous activities as it will result in some shin and calf pain. The Veteran denied flare-ups. On range of motion of testing, the Veteran had right and left knee flexion to 140 degrees or greater. There was no objective evidence of pain in the left knee, but pain at 0 degrees was noted in the right knee. He also had left and right knee extension to 0 degrees or any degree of hypertension with no objective evidence of painful motion. There was no additional limitation in range of motion following repetitive use testing. Additionally, there was no functional loss and/or functional impairment of the lower leg. Further, there was no tenderness or pain to palpitation for joint line or soft tissue. Muscle strength test was normal and there was no evidence of instability, patellar subluxation/dislocation, or joint replacement. Shin splints were noted. A final VA knee and lower leg conditions examination was provided in May 2016. At that time, the Veteran reported that he had not received treatment for his service-connected disabilities since the last VA examination. However, he stated that he continued to have intermittent anterior shin pain bilaterally. Running and jogging aggravated the disability. The Veteran did not do any intervention for his bilateral shin splints. He denied having calf pain. Flare-ups were also denied. Range of motion testing was normal with no evidence of pain. There was no pain with weight bearing. There was no additional functional loss or range of motion following repetitive use testing. Muscle strength testing was normal and there was no evidence of ankylosis or instability. Analysis After a review of the evidence, the Board finds that the preponderance of the evidence is against the assignment of an initial compensable rating for left leg shin splints. The preponderance of the evidence is also against the assignment of an initial rating in excess of 10 percent for right leg shin splints. With regards to the left leg shin splints, the evidence shows subjective complaints of periodic pain, without limitation of motion. There has been no showing of slight knee or ankle disability. As detailed herein, at the time of the October 2012 VA examination, the Veteran denied any recurrent ongoing problems with his lower legs, to include functional limitation. Range of motion testing was normal with no evidence pain. There was no finding of disability of the knee or ankle. During the May 2016 VA examination, the Veteran complained of pain with running. Notwithstanding, range of motion was within normal limits. Again, there was no finding of disability involving the knee or ankle. In light foregoing, the Board finds that an initial compensable rating is not warranted. 38 C.F.R. § 4.71a, Diagnostic Code 5262 (2017). As for the right leg shin splints, the evidence shows subjective complaints of pain. However, there is no evidence of moderate knee or ankle involvement. As noted herein, at the time of the October 2012 VA examination, the Veteran denied any recurrent ongoing problems with his lower legs, to include functional limitation. Range of motion testing revealed flexion to 140 degrees with evidence of pain. There was no finding of disability of the knee or ankle. At that time of the May 2016 VA examination, there were subjective complaints of pain, however, on objective testing, range of motion was normal and there was no evidence of pain. There was also no finding of disability of the knee or ankle. In light of the foregoing, the Boards that an initial rating in excess of 10 percent is not warranted. 38 C.F.R. § 4.71a, Diagnostic Code 5262 (2017). The Board has considered additional limitation of function per 38 C.F.R. §§ 4.40, 4.45, 4.59 and DeLuca v. Brown, 8 Vet. App. 202, 206-07 (1995). In this regard, the record is clear that the Veteran reports experiencing pain, particularly after physical activity. Pain itself, however, does not constitute functional loss. Rather, the pain must produce functional loss which results in disability which more nearly approximates the next higher rating in order to warrant a higher rating. After reviewing the record, the Board concludes that the objective evidence does not reflect the functional equivalent of symptoms, supported by adequate pathology, required for the assignment of ratings in excess of those assigned herein based on functional loss, including due to pain. Additionally, the Board has considered all potentially applicable diagnostic codes in accordance with Schafrath v. Derwinski, 1 Vet. App. 589 (1991), but the Veteran’s bilateral shin splint disability could not receive a higher rating under an analogous diagnostic code. See 38 C.F.R. § 4.115(b). Specific consideration has been given to increased ratings under Diagnostic Code 5022, which contemplates an increased rating based limitation of motion or as degenerative arthritis under Diagnostic Code 5003. However, the record contains no evidence that the Veteran’s shin splint disabilities have caused any limitation of motion. Thus, a higher rating is not warranted under Diagnostic Code 5022. 38 C.F.R. § 4.71a. In summary, the Board has considered the entire record, including the Veteran’s reported symptomatology and the objective clinical evidence. For the reasons set forth above, the Board concludes that the preponderance of the evidence is against the assignment of an initial compensable rating for left leg shin splints with calf muscular strain and the assignment of an initial rating in excess of 10 percent for right leg shin splints with calf muscular strain. Thus, the benefit of the doubt rule does not apply. 38 U.S.C. § 5107(b); see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 4. Entitlement to an initial compensable rating for headaches The Veteran’s headache disability has been assigned a noncompensable rating under Diagnostic Code 8100, which contemplates migraine headaches. Under the applicable rating criteria, a 10 percent rating is assigned for migraines with characteristic prostrating attacks averaging one in 2 months over the last several months. A 30 percent rating is assigned for migraines with characteristic prostrating attacks occurring on average once a month over the last several months. Finally, a maximum 50 percent rating is assigned for very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. 38 C.F.R. § 4.124a, Diagnostic Code 8100. The Board observes that the rating criteria do not define “prostrating.” Dorland’s Illustrated Medical Dictionary defines “prostration” as “extreme exhaustion or powerlessness.” See Dorland’s Illustrated Medical Dictionary 1531 (32nd ed. 2012). Similarly, the rating criteria also do not define “severe economic inadaptability.” However, the Court has indicated that, while there need not be a showing of unemployability, at a minimum, there should be an indication that the headaches are capable of interfering with the ability to earn money from work. Pierce v. Principi, 18 Vet. App. 440 (2004). Factual Background The Veteran underwent a VA headaches examination in October 2012. At the time of the examination, the Veteran reported frequent headaches involving the bitemporal region and forehead since the Fall of 2011. He described squeezing pain, but no pulsating or throbbing pain was noted. Headaches were fairly stable and occurred about once or twice per month on average. The headaches lasted approximately 3 to 4 hours. There was no aura associated with headaches. The Veteran also denied photophobia, phonophobia, vomiting, nausea, blurred vision, or diplopia associated with the headaches. He stated that the headaches were not necessarily prostrating in nature and that he could usually continue to function fairly normally with headaches. The Veteran stated that he took over the counter medication to treat headache pain. With regards to headache symptoms, the examiner indicated that the Veteran had constant headache pain. He did not experience any non-headache symptoms. The duration of typical head pain was less than 1 day. The Veteran did not have characteristic prostrating attacks or very frequent prostrating and prolonged attacks of migraine or non-migraine headache pain. A final VA examination was provided in May 2016. At that time, the Veteran reported that he no longer had tension headaches and did not take any medication to treat the service-connected disability. The examiner noted that the Veteran did not experience headache pain or non-headache symptoms associated with his headache disability. The Veteran did not have characteristic prostrating attacks of migraine or non-migraine headache pain. Analysis Based on a review of the evidence, the Board finds that the preponderance of the evidence is against the assignment of an initial compensable for the Veteran’s headache disability. As detailed above, the Veteran’s headache disability has been manifested by headache pain. However, the Veteran’s headache disability has not been manifested by characteristic prostrating attacks averaging one in 2 months over the last several months to warrant a compensable rating. Notably, in the report of the October 2012 VA examination, the Veteran reported headaches occurring about once or twice per month on average, but indicated that they did not cause prostrating attacks nor did they result in significant functional impairment. The examiner concluded that the Veteran did not exhibit characteristic prostrating headache attacks. The Veteran denied any headache pain at the time of the May 2016 VA examination. As such, the next-higher 10 percent higher rating is not warranted. 38 C.F.R. § 4.124a, Diagnostic Code 8100. For the reasons set forth above, the Board finds that the preponderance of the evidence is against the assignment of an initial compensable rating for the Veteran’s service-connected headache disability. The benefit-of-the-doubt doctrine is therefore not for application, and the claim must be denied. See 38 U.S.C. § 5107(b). REASONS FOR REMAND 1. Entitlement to an initial rating in excess of 50 percent for PTSD is remanded. The Veteran asserts that a rating in excess of 50 percent is warranted for his service-connected psychiatric disability. VA clinical records show treatment for PTSD and related symptoms. In records dated from April 2012 to June 2012, it was reported that the Veteran received psychiatric treatment from Southwestern Behavioral Health. However, records from Southwestern Behavioral Health have not been associated with the claims file. On remand, the Agency of Original Jurisdiction (AOJ) must obtain outstanding private treatment records. 2. Entitlement to an initial rating in excess of 10 percent for chronic low back strain with degenerative disc disease is remanded. The Veteran asserts that a rating in excess of 10 percent is warranted for his service-connected low back disability. The Veteran was provided a VA examination in May 2016. At that time, it was noted that the Veteran’s low back disability had been evaluated by a civilian orthopedic doctor. He was prescribed medication and referred physical therapy. VA clinical records confirm private medical treatment for the Veteran’s low back disability. Notably, in VA clinical records dated in July 2016, it was reported that the Veteran was under the care of Dr. W. at Tri-State Orthopedic. Private treatment records for the Veteran’ service-connected low back disability have not been associated with the claims file. On remand, outstanding private treatment records must be obtained. The matter is REMANDED for the following action: 1. The AOJ should request that the Veteran provide the names and addresses of any and all health care providers who have provided treatment for his PTSD and low back disability, to specifically include Southwestern Behavioral Health and Tri-State Orthopedic. After obtaining any necessary information and authorization from the Veteran, the AOJ should undertake the necessary efforts to obtain any additional private medical records pertinent to the Veteran’s claims. K. Conner Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C. Jones, Counsel