Citation Nr: 18160026 Decision Date: 12/21/18 Archive Date: 12/20/18 DOCKET NO. 17-02 280 DATE: December 21, 2018 REMANDED Entitlement to an evaluation in excess of 20 percent for service-connected traumatic arthritis of the lumbar spine is remanded. The issue of entitlement to a total disability rating based on unemployability (TDIU) is remanded. REASONS FOR REMAND 1. Entitlement to an evaluation in excess of 20 percent for service-connected traumatic arthritis of the lumbar spine is remanded. The Veteran was afforded a VA examination in December 2015 to assess the nature and severity of his lumbar spine disability. At that time, the VA examiner noted that he was unable to test the Veteran’s back for range of motion due to pain. In an April 2016 statement, the Veteran expressed that while he was in pain during the December 2015 examination, range of motion testing was completed, but very limited, due to the pain. The Veteran indicated that he completed the requested movements until such point as he felt unable to, yet no range of motion measurements were recorded. The Board finds that the appeal for the Veteran’s back disability must be remanded for another VA examination so that range of motion testing can be performed and the current severity of his lumbar spine disorder can be properly assessed. The Board acknowledges the Veteran’s reports of severe pain but reminds the Veteran that range of motion testing is critical in determining the severity of his musculoskeletal disability. To the extent possible, such testing should be performed, and the results properly recorded, to enable VA to properly rate his disability. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007); see also Kowalski v. Nicholson, 19 Vet. App. 171, 179 (2005) (a VA examination must be based on an accurate factual premise). The Board notes, further, that the evidence of record indicates that the Veteran’s lumbar spine disability may have worsened since his last VA examination. The Board finds that he should be afforded a new examination in order to determine the current nature and severity of this service-connected disability. See Snuffer v. Gober, 10 Vet. App. 400, 403 (1997). Additionally, the Board notes that the United States Court of Appeals for Veterans Claims (Court) recently addressed what constitutes an adequate explanation for an examiner’s inability to estimate motion loss in terms of degrees during periods of flare-ups. Sharp v. Shulkin, 29 Vet. App. 26 (2017). In Sharp, the Court held that a VA examiner must attempt to elicit information from the record and the Veteran regarding the severity, frequency, duration, or functional loss manifestations during flare-ups before determining that an estimate of motion loss in terms of degrees could not be given. It also held that any inability to furnish such an estimate must be predicated on a lack of medical knowledge among the medical community at large, rather than insufficient knowledge by the examiner. Id. 2. Entitlement to a TDIU is remanded. The claim for entitlement to a TDIU is inextricably intertwined with the pending issue of entitlement to an increased rating for traumatic arthritis of the lumbar spine. Therefore, the Board will not issue a decision on the claim at this time. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (issues are inextricably intertwined when they are so closely tied together that a final Board decision cannot be rendered unless both are adjudicated). The matter is REMANDED for the following action: 1. Obtain any updated VA and private treatment records pertinent to the claim and associate them with the claims file. 2. After completion of the foregoing, schedule the Veteran for a VA examination by an appropriate medical professional to determine the current severity of his lumbar spine disability. The examiner must be provided access to the claims file, including a copy of this remand. All necessary tests and studies, to include X-rays and range of motion studies, should be completed, and all clinical findings reported in detail. The examiner must: (a) Conduct range of motion testing of the Veteran’s lumbar spine, expressed in degrees in active motion, passive motion, weight-bearing, and nonweight-bearing. The examiner is requested, to the extent possible, to provide estimates of range of motion if the Veteran asserts he is unable to perform range of motion testing due to pain. (b) Render specific findings as to whether, during the examination, there is objective evidence of pain on motion, weakness, excess fatigability, or incoordination associated with the lumbar spine. If pain on motion is observed, the VA examiner should indicate the point at which pain begins. (c) Indicate whether, and to what extent, the Veteran experiences functional loss of his lumbar spine due to pain or any other symptoms during flare-ups or with repeated use. To the extent possible, the VA examiner should express any additional functional loss in terms of additional degrees of limited motion. (d) Discuss the functional effects of the Veteran’s lumbar spine disability. A complete rationale must be provided for all opinions offered. If an opinion cannot be offered without resort to mere speculation, the examiner must fully explain why this is the case and identify what additional evidence, if any, would allow for a more definitive opinion. CAROLINE B. FLEMING Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD G.C., Associate Counsel