Citation Nr: 18160254 Decision Date: 12/26/18 Archive Date: 12/26/18 DOCKET NO. 16-19 309 DATE: December 26, 2018 ORDER Service connection for sinusitis is granted. From January 19, 2016 to June 27, 2016, a rating of 40 percent for status post lumbar spine surgery with degenerative arthritis and compression deformity at L4 is granted, subject to the laws and regulations governing the payment of monetary awards. From January 19, 2016, a rating in excess of 40 percent for status post lumbar spine surgery with degenerative arthritis and compression deformity at L4 is denied. From January 1, 2013 to June 27, 2016, an initial rating of 30 percent for migraine headaches is granted, subject to the laws and regulations governing the payment of monetary awards. An initial rating in excess of 30 percent for migraine headaches is denied. REMANDED Service connection for left eye iritis is remanded. Service connection for right upper extremity cubital tunnel syndrome is remanded. Service connection for left upper extremity cubital syndrome is remanded. Prior to January 19, 2016, a rating in excess of 10 percent for status post lumbar spine surgery with degenerative arthritis and compression deformity at L4 is remanded. A compensable rating for radiculopathy of the right lower extremity prior to June 28, 2016, and in excess of 20 percent thereafter, is remanded. A compensable rating for radiculopathy of the left lower extremity prior to June 28, 2016, and in excess of 20 percent thereafter, is remanded. An initial compensable rating for gastroesophageal reflux disease (GERD) is remanded.   FINDINGS OF FACT 1. The Veteran’s sinusitis is related to service. 2. From January 19, 2016, the Veteran’s low back disorder approximates flexion to 30 degrees or less when considering functional loss, including pain, and difficulty with prolonged sitting and standing, exercising, bending, driving and dressing himself; but there are no symptoms of unfavorable ankylosis of the entire thoracolumbar spine. 3. From January 1, 2013, the Veteran’s migraine headaches most closely approximate characteristic prostrating attacks averaging once a month over the last several months, but without attacks productive of severe economic inadaptability. CONCLUSIONS OF LAW 1. The criteria for service connection for sinusitis have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. From January 19, 2016 to June 27, 2016, the criteria for a 40 percent rating for the low back disorder have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code (DC) 5237. 3. From January 19, 2016, the criteria for a rating in excess of 40 percent rating for the low back disorder have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, DC 5237. 4. From January 1, 2013, to June 27, 2016, the criteria for an initial 30 percent rating for migraine headaches have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.3, 4.7, 4.114, DC 8100. 5. From January 1, 2013, the criteria for an initial rating in excess of 30 percent for migraine headaches have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.3, 4.7, 4.114, DC 8100. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Air Force from December 1990 to December 2012. The case is on appeal from a December 2013 and June 2016 rating decisions. By a December 2013 rating decision, the Regional Office (RO) granted service connection for the low back disability and awarded a 10 percent rating from January 1, 2013. The decision also granted service connection for migraines and awarded a noncompensable rating from January 1, 2013. Thereafter, in a June 2016 rating decision, the RO increased the Veteran’s low back disability rating to 40 percent and his migraine rating to 30 percent, effective June 28, 2016. Despite these increases, the increased rating matters remain in appellate status as the maximum ratings have not been assigned. See AB v. Brown, 6 Vet. App. 35, 38 (1993). In the June 2016 rating decision, the RO granted service connection for bilateral lower extremity radiculopathy with 20 percent ratings assigned from June 28, 2016. The Board finds the radiculopathy rating issues are essentially part and parcel of the low back rating claim, and as the ratings do not commence from the earliest possible effective date stemming from the underlying claim for increase for the service-connected low back disability or constitute the highest possible ratings for radiculopathy, the Board will take jurisdiction over the issues as characterized on the title page. See 38 C.F.R. § 4.71a, DC 5237, Note 1 (evaluate any associated objective neurologic abnormalities...separately). The Board has limited its discussion below to the relevant evidence required to support its findings of fact and conclusions of law, as well as to the specific contentions regarding the case as raised directly by the Veteran and those reasonably raised by the record. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008). Although the Board is remanding the remaining issues for further development, remand is not necessary for the claims decided herein as there is no reasonable possibility that further assistance would substantiate these claims. See 38 C.F.R. § 3.159(d). Service Connection Service connection for sinusitis. Legal Criteria Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. § 1110; 38 C.F.R. § 3.303. “To establish a right to compensation for a present disability, a veteran must show: “(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service” the so-called “nexus” requirement.” Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). In addition, in determining whether service connection is warranted for a disability, 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 the claim, in which case the claim is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Analysis The Veteran seeks service connection for sinusitis. The Veteran’s service treatment records reflect significant in-service treatment and complaints for sinusitis. A December 2007 service treatment record indicated the Veteran reported a sinus infection. A March 2012 record near the end of the Veteran’s lengthy period of active service noted a diagnosis of ethmoid, sphenoid, and maxillary mucosal sinus disease, as well as mild leftward deviation of the nasal septum. An April 2012 service record also indicated reports of chronic sinusitis. The Veteran was afforded an October 2012 VA examination in which he reported sinusitis, a deviated septum and an upper respiratory infection during service. The examiner indicated the Veteran does not have chronic sinusitis. However, the examiner also stated the Veteran’s medical history includes a nose, sinus, mouth and/or throat condition, to include sinusitis. The Veteran submitted a January 2016 substantive appeal in which he indicated he was diagnosed with sinusitis that his physician reported as degenerative chronic sinusitis. He stated he requires medication for ethmoid, sphenoid, and maxillary mucosal sinus disease. The Board finds the Veteran has a current sinus disability which is related to service and therefore, service connection for sinusitis is warranted. The Veteran had ongoing sinus treatment, including being diagnosed with sinusitis, throughout his service treatment records. Although the October 2012 VA examiner indicated there was no diagnosis of sinusitis, he later reported there was a medical history of sinusitis. Thus, the Board determines the Veteran has a current disability of sinusitis which had its onset during service. The evidence is in equipoise, and thus, resolving doubt in favor of the Veteran, service connection for sinusitis is warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Increased Rating General Legal Criteria Ratings are based on a schedule of reductions in earning capacity from specific injuries or combination of injuries. The ratings shall be based, as far as practicable, upon the average impairments of earning capacity resulting from such injuries in civil occupations. 38 U.S.C. § 1155. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. 38 C.F.R. § 4.1. 1. A rating for the service-connected low back disability in excess of 10 percent prior to June 28, 2016, and in excess of 40 percent thereafter. Legal Criteria The General Rating Formula for evaluating the spine provides for a 10 percent disability rating for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; 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 disability rating is assigned for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; 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 disability rating is assigned for forward flexion of the thoracolumbar spine to 30 degrees or less or favorable ankylosis of the entire thoracolumbar spine. A 50 percent disability rating is assigned for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent rating is warranted for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, DC 5237. When evaluating joint disabilities rated on the basis of limitation of motion, VA may consider granting a higher rating in cases in which functional loss due to pain, weakness, excess fatigability, or incoordination is demonstrated, and those factors are not contemplated in the relevant rating criteria. See 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca v. Brown, 8 Vet. App. 202 (1995). Facts and Analysis During the October 2012 VA examination, the Veteran reported flare-ups, including that he could not bend or twist without pain, and his condition had worsened, including pain and numbness which radiated down his left leg. He reported he had a lumbar fusion surgery in 2005 and his disability had degenerated since that time. Range of motion testing showed flexion to 65 degrees with no reduced motion after repetition. Functional loss included less movement than normal and pain on movement. The examiner stated no radiculopathy was found or ankylosis. The Veteran submitted an October 2014 notice of disagreement (NOD) in which he indicated he must take time off from work because of back pain and he has ongoing pain and numbness into his leg. He then submitted a substantive appeal received January 19, 2016 in which he stated his back disability has worsened over time, including reduced range of motion. He reported he is unable to perform many normal functions, such as exercise, standing, sitting and riding in a car. He further indicated his activities of daily living are limited and he is in constant pain and discomfort. The Veteran was afforded a June 2016 VA examination in which he reported flare-ups, including with movement and turning, causing his back to “lock up.” He reported an inability to exercise, bend over, drive or even dress himself. Range of motion testing revealed flexion to 30 degrees and repetition caused the Veteran extreme pain and instability of his legs. Additionally, the examiner noted radiculopathy of both lower extremities, found to be moderate in the right leg and mild in the left. No ankylosis was indicated. However, the examiner indicated the Veteran has significant back pain with prolonged sitting and standing, even for short periods of time. After a careful review of the evidence, the Board finds that the Veteran’s service-connected low back disability most closely approximates a 40 percent rating, but not higher, from January 19, 2016, the date of his substantive appeal. He asserted in the substantive appeal that his back disability had significantly worsened, causing severe pain and limiting his range of motion and normal functions. Thus, from the January 2016 substantive appeal, the Veteran’s symptoms suggest forward flexion of the thoracolumbar limited to 30 degrees or less, when accounting for functional loss. The Board finds that while the RO increased the Veteran’s rating to 40 percent effective June 28, 2016, the evidence supports a factually ascertainable increase in disability to 40 percent as early as January 19, 2016. This is based on the Veteran’s credible report of severe and worsening symptoms, as well as the subsequent range of motion findings by the June 2016 VA examiner. 38 C.F.R. § 4.71a, DC 5237; see also Swain v. McDonald, 27 Vet. App. 219, 224 (2015). Thus, the Board determines the Veteran’s low back disability most closely approximates an increased rating to 40 percent from January 19, 2016, particularly when affording him the benefit of the doubt. See 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3. While an increased initial rating to 40 percent is warranted for the Veteran’s low back disability since January 19, 2016, an increase in excess of 40 percent is not supported. Accordingly, the applicable rating criteria do not warrant an increase in excess of 40 percent. In this regard, the record does not show and the Veteran does not contend that he experienced unfavorable ankylosis of the entire thoracolumbar spine or unfavorable ankylosis of the entire spine at any point. In addition, a higher rating in excess of 40 percent based on intervertebral disc syndrome (IVDS) is not warranted as the evidence does not show and the Veteran does not claim that his back disability caused IVDS with incapacitating episodes having a total duration of at least six weeks during the past 12 months. 38 C.F.R. § 4.71a, DC 5243. With regard to the assigned 40 percent rating, the Board finds there is no other basis to assign a disability rating higher than 40 percent. Even though the VA examinations may not contain all the necessary findings to evaluate the Veteran’s loss of function, including on weight bearing and during flare-ups, a higher rating cannot be assigned regardless of these findings absent ankylosis. See 38 C.F.R. § 4.71a, DC 5237; see also Spencer v. West, 13 Vet. App. 376, 382 (2000); Johnston v. Brown, 10 Vet. App. 80, 84-85 (1997). Accordingly, for the period from January 19, 2016, remand for a new VA examination is not needed pursuant to Sharp v. Shulkin, 29 Vet. App. 26, 35-36 (2017), and Correia v. McDonald, 28 Vet. App. 158, 168 (2016). Although the Board is remanding several claims, including for a rating in excess of 10 percent for the low back disorder prior to January 19, 2016, remand is not necessary for the low back disability from January 19, 2016. The Board finds there is no reasonable possibility that further assistance would substantiate this claim. See 38 C.F.R. § 3.159(d). In sum, after resolving reasonable doubt in the Veteran’s favor, the evidence of record shows that the Veteran began experiencing forward flexion of his back, approximating limitation to 30 degrees or less from January 19, 2016, the date of his substantive appeal. In consideration of the evidence, the Board finds that from January 19, 2016, a rating of 40 percent, but not higher, is warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3. 2. A compensable rating for the service-connected migraine headaches prior to June 28, 2016, and in excess of 30 percent thereafter. Legal Criteria Under DC 8100 pertaining to headaches, a noncompensable rating is assigned for less frequent attacks. A 10 percent rating requires that the condition be productive of headaches with characteristic prostrating attacks averaging one in two months over last several months. A 30 percent rating requires headaches with characteristic prostrating attacks occurring on an average once a month over the last several months. A 50 percent rating requires that the disability be manifested by very frequent and prostrating and prolonged attacks that are productive of severe economic inadaptability. 38 C.F.R. § 4.124a, DC 8100. The rating criteria do not define “severe economic inadaptability.” “Productive of economic inadaptability” can be read as having either the meaning of “producing” or “capable of producing” severe economic inadaptability. See Pierce v. Principi, 18 Vet. App. 440, 445 (2004). However, nothing in DC 8100 requires the claimant to be completely unable to work in order to qualify for a 50 percent rating. Id. at 440. Facts and Analysis The Veteran was afforded an October 2012 VA examination in which he reported his migraine symptoms include headaches that cause a “squeezing sensation on the head or center over the eyes.” The examiner indicated he requires medication for the disorder and experiences pain on both sides of his head, as well as sensitivity to light and sound. The duration of the indicated headaches is less than one day and he experiences no characteristic prostrating attacks of migraine or headache pain. The examiner stated the Veteran’s migraines impact his ability to work by causing difficulty performing physical activities during flare-ups. In the Veteran’s October 2014 NOD, he stated his headaches prevent him from performing normal activities and many times, he is forced to find a quiet, dark place to improve his symptoms. He stated his migraines can last more than one day and have interfered with his work. Similarly, in the January 2016 substantive appeal, he indicated he suffers migraines approximately 1-2 times per month and has tried numerous medications which have not improved the symptoms. During the Veteran’s June 2016 VA examination, he reported getting headaches on average twice per month, throbbing and pulsating in nature and in the frontal area of his head. He stated the pain radiates around his head forcing him to take medication and he lays down in a dark, quiet room to improve his symptoms. The examiner noted symptoms of pulsating or throbbing pain, pain on both sides of his head, worsening pain with physical activity, nausea, vomiting, sensitivity to light and sound, and pain lasting 1-2 days. She indicated the Veteran has characteristic prostrating attacks once per month with no pain productive of severe economic inadaptability. She noted the Veteran works for Microsoft and he experiences incapacitating headaches that keep him at home; however, he is able to so some of his work remotely. In view of the evidence, and resolving reasonable doubt in the Veteran’s favor, the Board finds that the Veteran’s migraine symptoms more closely approximate the criteria for a 30 percent rating, but not higher, under DC 8100, from the date following separation from service, January 1, 2013. See 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.7. Thus, an initial 30 percent rating for migraine headaches is warranted, effective January 1, 2013. The Veteran’s migraine symptoms support significant headaches with characteristic prostrating attacks occurring on an average of once a month, since January 1, 2013. The October 2012 VA examiner indicated the duration of the Veteran’s migraines is less than one day and he experiences no characteristic prostrating attacks. However, in his subsequent October 2014 NOD and January 2016 substantive appeal, he reported his migraines prevent him from performing normal activities and he is often forced to find a quiet, dark place to improve his symptoms. He stated his migraines can last more than one day, interfere with his work and occur approximately 1-2 times per month. Therefore, despite the October 2012 examiner’s indication of no prostrating headaches, the Board finds the Veteran’s migraine symptoms overall most closely approximate severe headaches with characteristic prostrating attacks occurring on an average of once a month. Thus, the Board determines a 30 percent rating is supported from January 1, 2013. While an increased rating to 30 percent is warranted from January 1, 2013, the evidence does not indicate that the maximum disability rating of 50 percent is warranted for the Veteran’s headaches at any time during the pendency of the appeal. The Board finds that the preponderance of the evidence weighs against finding that the Veteran’s headaches were productive of or capable of producing economic inadaptability. See Pierce, 18 Vet. App. at 444-45. First, the Board notes that the Veteran reported having migraines no more than twice per month on average. See June 2016 VA Examination Report; January 2016 VA Form 9. The Board finds that this reported frequency does not rise to the level of “very frequent” attacks, as required by the criteria for a 50 percent rating. See Johnson v. Wilkie, No. 16-3808, 2018 U.S. App. Vet. Claims LEXIS 1253 * 16 (Vet. App. Sep. 19, 2018) (holding that the criteria of DC 8100 are successive and thus require that all of the enumerated criteria for a specific rating be met); see also Tatum v. Shinseki, 23 Vet. App. 152, 156 (2009). Additionally, while the evidence shows the Veteran’s migraine symptoms have an impact on his work, the record contains no evidence suggestive that there was severe economic inadaptability. As noted, he has reported that his migraines interfere with his work in that he has had to take days off from work; however, at the June 2016 VA examination the Veteran reported that he works Microsoft and when he has incapacitating headaches that keep him at home, he is able to work remotely. This evidence weighs against a finding of severe economic impact causing inadaptability, as it demonstrates that the Veteran need not take a day off from work every time he suffers from a migraine headache (which, as noted, occurs no more than twice per month on average). The Veteran’s reports show that although he stays home, he is capable of adapting his schedule to work remotely, which supports a finding that his headaches do not have a severe economic impact on his ability to work. Moreover, because the Veteran is able to adapt to a work environment in this way, his disability is not capable of producing “severe economic inadaptability,” as required for a 50 percent rating. See Pierce, 18 Vet. App. at 444-45. The Board acknowledges that there is economic impairment and also acknowledges the severity of the Veteran’s symptoms. However, based on his reports and medical assessments, it is apparent that the Veteran has been able to adapt economically and occupationally to his symptoms. The Board therefore finds that the Veteran’s headaches are not actually productive of, and are not capable of, producing severe economic inadaptability. Although the Board is remanding several claims, remand is not necessary for the migraine disability. The Board finds there is no reasonable possibility that further assistance would substantiate this claim. See 38 C.F.R. § 3.159(d). Therefore, the Board finds that from the date following separation from service, the Veteran’s migraine headaches approximate the impairment level of characteristic prostrating attacks occurring on an average once a month over last several months, and a 30 percent rating is warranted. However, the evidence does not show that the Veteran’s migraine headache symptoms meet the criteria for the next higher rating of 50 percent. Accordingly, an initial rating of 30 percent, but not higher, is warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3. REASONS FOR REMAND 1. Service connection for left eye iritis. The Veteran contends he has a left eye disorder which had its onset during service. He had significant left eye complaints and treatment during service. A December 2006 service treatment record indicated he received treatment for acute secondary infectious iritis. December 2007 and July 2008 service records also noted acute iritis. Further, a May 2012 record indicated acute secondary infectious iritis. The Veteran was afforded an October 2012 VA examination in which the examiner indicated no left eye disorder was diagnosed. He stated with regard to the Veteran’s claimed left eye iritis and conjunctivitis, there was no diagnosis because the conditions had resolved. In the Veteran’s January 2016 substantive appeal, he indicated he continues to suffer from a constant reddened left eye and it could be due to his left eye scarring. He stated this redness has prevented him from obtaining corrective surgery. Due to the Veteran’s reports of a left eye symptoms and an ongoing left eye disorder, the Board finds an additional VA examination is required to determine the nature and etiology of any diagnosed left eye condition. 2. Service connection for right and left upper extremity cubital tunnel syndrome. The Veteran contends that he has left and right cubital tunnel syndrome. His service treatment records contain complaints and treatment for the upper extremity disorders. A May 2005 service record noted the Veteran was experiencing decreased strength and range of motion, and loss of sensation in his upper extremities, to include his elbows. October and December 2007 service records indicated lateral epicondylitis (tennis elbow). A June 2012 record noted a partial tear of the common extensor tendon at the lateral epicondyle attachment and an otherwise negative MRI of the right elbow. The October 2012 VA examiner indicated there was no cubital tunnel syndrome present as the conditions had resolved. The Veteran’s January 2016 substantive appeal indicated he continues to experience cubital tunnel syndrome due to many years of working with computers and as a computer administrator during service, including typing and using the mouse. He reported due to the disorder, he experiences bouts of numbness and tingling in his hands, as well as pain. In light of the additional evidence submitted, the Board finds the Veteran’s competent lay statements tend to suggest recurrent cubital tunnel syndrome symptoms and therefore, an additional VA examination is required. Furthermore, pain alone may constitute a disability, even without an identifiable pathology. See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). 3. A rating in excess of 10 percent for the low back disability, prior to January 19, 2016. 4. Compensable ratings prior to June 28, 2016, for radiculopathy of the right and left lower extremities, and in excess of 20 percent thereafter. The current decision increased the Veteran’s low back rating to 40 percent effective January 19, 2016 and denied a rating in excess of 40 percent from that date. However, prior to January 19, 2016, the Veteran’s claim requires remand for further development. In this regard, the Veteran was afforded VA examinations in October 2012 and June 2016 which assessed the severity of his low back disability. However, these examination reports do not include detailed range of motion findings or findings regarding functional loss, per the recent precedential decisions of Correia v. McDonald, 28 Vet. App. 158 (2016) (instructing that VA orthopedic examinations should include tested for pain on both active and passive motion, in weight-bearing and nonweight-bearing (if applicable) and, if possible, with the range of the opposite undamaged joint), and Sharp v. Shulkin, 29 Vet. App. 26 (2017) (outlining VA examiners’ obligation to elicit information regarding flare-ups of a musculoskeletal disability if the examination is not conducted during such a flare-up, and to use this information to characterize additional functional loss during flare-ups). While the Board has concluded that the Veteran’s low back disability is entitled to a 40 percent rating, but not higher, as of January 19, 2016, the rating for the disability prior to such date remains on appeal. Therefore, this claim is remanded for a VA examination to obtain retrospective findings in accordance with Correia and Sharp based on the historic range of motion testing noted above. As noted, increased ratings for bilateral lower extremity radiculopathy are part and parcel of the lumbar spine claim and as such, should also be addressed by the examiner on remand. 5. A compensable initial rating for GERD. The Veteran was afforded was afforded an October 2012 VA examination for his service-connected GERD. Symptoms noted by the examiner included pyrosis (heartburn) and reflux and were reported as intermittent. A December 2013 addendum opinion confirmed a diagnosis of GERD for the Veteran. In the January 2016 substantive appeal, the Veteran indicated his GERD symptoms may have worsened. He stated he continues to get reflux and was scheduled to have an upper GI study and colonoscopy to determine the long-term effects of his reflux and heartburn. As the Veteran has suggested worsening GERD symptoms, he should be afforded a new VA examination to determine the current severity of the disorder. See Snuffer v. Gober, 10 Vet. App. 400 (1997). The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination by an appropriate medical professional to determine the nature and etiology of any left eye disability. All necessary tests should be conducted. The examiner should identify all of the Veteran’s left eye disabilities found during the relevant period on appeal (December 2012 to the present), including any functional impairments. The phrase “functional impairment” is defined as “the inability of the body or a constituent part of it to function under the ordinary conditions of daily life, including employment.” Additionally, the Board notes that pain alone can qualify as a disability “where it diminishes the body’s ability to function, even where it is not diagnosed as connected to a current underlying condition.” If no such left eye disability or functional impairment is identified, the examiner should explain the medical rationale underpinning the determination. For all disabilities and functional impairments identified, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that any left eye disorder or functional impairment had its onset in, or is otherwise related to, service, to include the documented complaints in the service treatment records. 2. Schedule the Veteran for a VA examination by an appropriate medical professional to determine the nature and etiology of any bilateral cubital tunnel syndrome or any other bilateral upper extremity disorder characterized by symptoms of pain, numbness and tingling in the Veteran’s hands. All necessary tests should be conducted. The examiner must identify any current left and/or right upper extremity disorder found during the appeal period (December 2012 to the present) including any functional impairments. The phrase “functional impairment” is defined as “the inability of the body or a constituent part of it to function under the ordinary conditions of daily life, including employment.” Additionally, the Board notes that pain alone can qualify as a disability “where it diminishes the body’s ability to function, even where it is not diagnosed as connected to a current underlying condition.” If no such disability or functional impairment is identified, the examiner should explain the medical rationale underpinning the determination. For all disabilities and functional impairments identified, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that any such disorder or functional impairment had its onset during, or is otherwise related to, service, to include the documented complaints in the service treatment records. 3. Obtain a medical opinion to address the severity of the Veteran’s service-connected low back disability prior to January 19, 2016, to include specific findings regarding pain on range of motion testing and an estimation of functional loss, per Correia and Sharp. An examination is not necessary unless deemed so by the examiner. Following a review of the record and examination, the examiner should provide retrospective findings in regard to pain on range of motion testing and an estimation of functional loss, per Correia and Sharp. Specifically, the examiner should estimate the amount in degrees of range of motion lost due to pain in both weight-bearing and nonweight-bearing positions, and on both active and passive motion experienced by the Veteran at the time of VA examinations conducted in October 2012 and June 2016. The examiner should also estimate the amount in degrees of range of motion lost due to flare-ups experienced by the Veteran at the time of VA examinations conducted in October 2012 and June 2016. In doing so, the examiner should consider the frequency, duration, characteristics, precipitating and alleviating factors, and severity of the Veteran’s flare-ups, and/or the extent of functional impairment the Veteran experiences during a flare-up of symptoms. The examiner should also identify, and comment on the frequency and severity of all neurological symptoms associated with the service-connected back disability, to include radiculopathy of the lower extremities. If the examiner cannot provide some or all of such retrospective opinions, the examiner must make clear that he or she has considered all relevant, procurable data, but that any member of the medical community at large could not provide such an opinion without resorting to speculation. 4. Schedule the Veteran for a VA examination by an appropriate medical professional to assess the severity of his service-connected GERD. TRACIE N. WESNER Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD B. Isaacs, Associate Counsel