Citation Nr: 18106986 Decision Date: 06/01/18 Archive Date: 05/31/18 DOCKET NO. 12-13 798 DATE: June 1, 2018 ORDER Entitlement to an increased rating for a lumbar spine disability, in excess of 10 percent as of April 16, 2008, in excess of 20 percent as of December 7, 2011, and in excess of 40 percent as of April 7, 2015, is denied. REMANDED Entitlement to a total disability rating based on unemployability due to service-connected disabilities (TDIU) is remanded. FINDINGS OF FACT 1. Between April 16, 2008, and December 6, 2011, the preponderance of the evidence indicates that the Veteran’s lumbar spine disability manifested in thoracolumbar spine forward flexion of more than 60 degrees, but not greater than 85 degrees, with muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour. 2. Between December 7, 2011, and April 6, 2015, the preponderance of the evidence indicates that the Veteran’s lumbar spine disability manifested in thoracolumbar spine forward flexion of more than 30 degrees, but less than 60 degrees, with no muscle spasm or guarding resulting in abnormal gait or abnormal spinal contour. 3. As of April 7, 2015, the preponderance of the evidence indicates that the Veteran’s lumbar spine disability manifested in thoracolumbar spine forward flexion of 30 degrees or less, with no favorable or unfavorable ankylosis of the spine. CONCLUSION OF LAW The criteria for an increased rating for a lumbar spine disability, in excess of 10 percent as of April 16, 2008, in excess of 20 percent as of December 7, 2011, and in excess of 40 percent as of April 7, 2015, have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5242. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from November 1965 to October 1969. The Veteran testified before the undersigned at an August 2013 hearing. A transcript of that hearing is of record. The Board remanded the claim in April 2014 for further development, including to obtain a new VA examination. In light of the VA examination conducted and further adjudicatory actions taken by the RO, the Board finds that there has been substantial compliance with the prior remand directives. Stegall v. West, 11 Vet. App. 268 (1998); D’Aries v. Peake, 22 Vet. App. 97 (2008); Dyment v. West, 13 Vet. App. 141 (1999). Accordingly, the Board will proceed with a decision. Increased Rating Upon receipt of a substantially complete application, VA must notify the claimant and any representative of any information, medical evidence, or lay evidence not previously provided to VA that is necessary to substantiate the claim. The notice must: (1) inform the claimant about the information and evidence not of record that is necessary to substantiate the claim; (2) inform the claimant about the information and evidence that VA will seek to provide; and (3) inform the claimant about the information and evidence the claimant is expected to provide. 38 U.S.C. §§5103, 5103A, 5107; 38 C.F.R. §3.159; Pelegrini v. Principi, 18 Vet. App. 112 (2004). If VA does not provide adequate notice of any of element necessary to substantiate the claim, or there is any deficiency in the timing of the notice, the burden is on the claimant to show that prejudice resulted from any notice error. Shinseki v. Sanders, 129 S.Ct. 1696 (2009). The Board finds that any defect with regard to the timing or content of the notice to the appellant is harmless because of the thorough and informative notices provided throughout the adjudication and because the appellant had a meaningful opportunity to participate effectively in the processing of the claim with an adjudication of the claim by the RO subsequent to receipt of the required notice. The record does not show prejudice to the appellant, and the Board finds that any defect in the timing or content of the notices has not affected the fairness of the adjudication. Mayfield v. Nicholson, 19 Vet. App. 103 (2005); Dingess v. Nicholson, 19 Vet. App. 473 (2006). Specifically, the Veteran was notified in letters dated in April 2008. The Veteran has neither alleged nor demonstrated any prejudice with regard to the content or timing of the notice provided. Shinseki v. Sanders, 129 S. Ct. 1696 (2009) (burden of showing an error is harmful or prejudicial falls on party attacking agency decision); Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006). The Board considers it significant that the subsequent statements made by the Veteran and representative suggest actual knowledge of the elements necessary to substantiate the claim. Dalton v. Nicholson, 21 Vet. App. 23 (2007) (actual knowledge is established by statements or actions by claimant or representative that demonstrate awareness of what is necessary to substantiate claim). Thus, VA has satisfied the duty to notify the appellant and had satisfied that duty prior to the adjudication in a July 2016 supplemental statement of the case. Overton v. Nicholson, 20 Vet. App. 427 (2006) (Veteran afforded a meaningful opportunity to participate effectively in adjudication of claim, and therefore notice error was harmless). The Board also finds that the duty to assist requirements have been fulfilled. All relevant, identified, and available evidence has been obtained, and VA has notified the appellant of any evidence that could not be obtained. The appellant has not referred to any additional, unobtained, relevant, available evidence. VA has obtained an examination with respect to the claims being decided. Thus, the Board finds that VA has satisfied the duty to assist. No further notice or assistance to the Veteran is required to fulfill VA's duty to assist in development. Smith v. Gober, 14 Vet. App. 227 (2000); Dela Cruz v. Principi, 15 Vet. App. 143 (2001); Quartuccio v. Principi, 16 Vet. App. 183 (2002). Disability ratings are determined by the application of VA's Schedule for Rating Disabilities. 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during service and the residual conditions in civil occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321 (a), 4.1. The determination of whether an increased rating is warranted is based on review of the entire evidence of record and the application of all pertinent regulations. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When there is an approximate balance of positive and negative evidence on any issue material to the determination of a matter, VA shall resolve reasonable doubt in favor of the claimant. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Lumbar Spine The Veteran's lumbar spine disability is rated under the General Rating Formula for Diseases and Injuries of the Spine for Diagnostic Codes 5235 to 5243. Diagnostic Code 5243 provides that intervertebral disc syndrome (IVDS) is to be rated either under the General Rating Formula for Diseases and Injuries of the Spine or under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, whichever method results in the higher rating when all disabilities are combined under 38 C.F.R. § 4.25. The General Rating Formula for Diseases and Injuries of the Spine provides that a 10 percent rating is assigned for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, the combined range of motion of the cervical spine greater than 120 degrees, but not greater than 235 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in an abnormal gait or abnormal spinal contour. A 20 percent rating is 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 rating is assigned for forward flexion of the thoracolumbar spine of 30 degrees or less, or for favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is assigned for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent rating is awarded for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine. For VA compensation purposes, normal forward flexion of the thoracolumbar spine is 0 to 90 degrees, extension is 0 to 30 degrees, left and right lateral flexion are 0 to 30 degrees, and left and right lateral rotation are 0 to 30 degrees. The normal combined range of motion of the thoracolumbar spine is 240 degrees. 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 ranges of motion for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion. The rater is to round each range of motion measurement to the nearest five degrees. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine, Notes (2), (4). For VA compensation purposes, unfavorable ankylosis is 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 (0 degrees) always represents favorable ankylosis. The rater is to round each range of motion measurement to the nearest five degrees. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine, Note (5). 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. The rater is to round each range of motion measurement to the nearest five degrees. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine, Note (6). The criteria are applied with and without symptoms such as pain (whether or not it radiates), stiffness, or aching in the area of the spine affected by residuals of injury or disease. 38 C.F.R. § 4.71a. Any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, should be rated separately under an appropriate Diagnostic Code. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine, Note (1). In exceptional cases, an examiner may state that because of age, body habitus, neurologic disease, or other factors not the result of disease or injury of the spine, the range of motion of the spine in a particular individual should be considered normal for that individual, even though it does not conform to the normal range of motion. Provided that the examiner supplies an explanation, the examiner's assessment that the range of motion is normal for that individual will be accepted. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine, Note (3). The present claim for an increased rating arises from service connection for a lumbar spine disability that was originally granted in a December 2009 rating decision. The Appellant contends that the ratings for a service-connected lumbar spine disability does not adequately compensate the severity of the disability. 1. Entitlement to a rating in excess of 10 percent for a lumbar spine disability prior to December 7, 2011. In January 2003, the Veteran reported to the emergency room with complaints of being unable to control his balance for the past month, slurred speech, several falls, and leg weakness. VA medical records indicate the Veteran was diagnosed with cerebellar ataxia that year. Subsequent VA medical records indicate that the Veteran had continued issues with balance and leg weakness due to the ataxia. An April 2005 private medical examination of the thoracolumbar spine found forward flexion to 70 degrees, extension to 10 degrees, and right and left lateral flexion to 15 degrees. April 2008 private medical records indicate that the Veteran reported constant, moderate pain in the lower back had returned. On examination, the examiner noted posterior displacement of the fifth lumbar vertebra, and subluxation at the right S1 joint. on palpation, there was a light amount of increased muscle tension in the lumbar paraspinal muscles, bilaterally. Evidence of moderate pain at L5, bilaterally, and the right ilium was also noted. July 2008 VA medical records indicate that the Veteran reported another flare-up of constant and moderate pain in the lumbar spine. The examiner noted a moderate degree of muscular hypertonicity in the lumbar paraspinal muscles, bilaterally. The examiner also noted moderate pain at L5, bilaterally, and the right ilium, on palpation. At a November 2009 VA examination, the Veteran reported intermittent lumbosacral pain, rated 6 out of 10. The pain was aggravated by bending and rising from a sitting position. The Veteran had difficulty with heavy lifting. The Veteran reported that the pain radiated down the lower extremities, bilaterally. The examiner noted that the Veteran used a walker due to cerebellar ataxia, but found that ambulation was not significantly impacted by the back pain. The Veteran reported he had not worked since 2002 due to cerebellar ataxia. The Veteran reported one flare-up every two to three months, lasting one week, during which there was increased pain, but no further functional impairment. On examination of the thoracolumbar spine, forward flexion was to 75 degrees, extension was to 30 degrees, right and left lateral flexion was to 40 degrees, and right and left lateral rotation was to 50 degrees. All movements had end of range pain, but no decrease in range of motion due to pain or fatigue following repetitive motion. The examiner noted no lumbosacral tenderness or spasm. Straight leg raise tests were negative, bilaterally. Motor and sensory examinations were normal, and reflexes were within normal limits. The Veteran’s gait was noted as wide and unsteady. An x-ray of the spine found multilevel degenerative disc disease, most pronounced in the lower lumbar spine, age-indeterminate anterior wedging of L1 and T12, and multilevel anterior osteophytes. The examiner diagnosed degenerative disc disease of the lumbar spine. From June 2011 through July 2011, VA medical records indicate that the Veteran underwent physical therapy for degenerative disc disease of the lumbar spine. During that time, the Veteran reported lower back pain, that occasionally radiated down the posterior thighs, bilaterally. The Veteran reported difficulty transferring, lifting, sleeping, driving, and dressing. On examination, tenderness to palpation was noted. The examiner noted decreased flexibility in the lumbar spine, but indicated range of motion was within functional limits. There was pain with all movements, and loss of balance. The Board finds that a rating in excess of 10 percent for a lumbar spine disability during this period is not warranted. The November 2009 VA examination showed that the lumbar spine disability manifested in forward flexion of greater than 60 degrees, but not greater than 85 degrees. The private medical records are consistent with that finding. Subsequent VA medical records show reduced range of motion in the lumbar spine, but do not indicate specific degrees. Further, the examiners in the records indicated that the range of motion was within functional limits. The preponderance of the evidence is against a finding that forward flexion was less than 60 degrees during this time, or that there was muscle spasm or guarding resulting in abnormal gait or abnormal spinal contour. The Board notes that the Veteran was diagnosed with cerebellar ataxia in 2003, and difficulty balancing and ambulating was attributed to this disorder. The Board has considered whether the application of another diagnostic code may enable a higher rating, including Diagnostic Code 5003 for degenerative arthritis. However, after review, the Board finds that no other diagnostic code provides for a higher or separate rating. 38 C.F.R. §§ 4.3, 4.7, 4.71(a). Further, there is no evidence of incapacitating episodes resulting from intervertebral disc syndrome, and thus a higher rating cannot be assigned using the criteria for rating intervertebral disc syndrome. 38 C.F.R. § 4.71a, Diagnostic Code 5243. In making a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which is found to be persuasive or unpersuasive, and provide the reasons for the rejection of any material evidence favorable to the claimant. Gabrielson v. Brown, 7 Vet. App. 36 (1994); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The Veteran is competent to report symptoms, such as pain, because that requires only personal knowledge as it comes to him through his senses. Layno v. Brown, 6 Vet. App. 465 (1994). However, the objective evidence does not demonstrate symptoms that more nearly approximate a higher rating under the schedule of ratings for the musculoskeletal system during this period. Accordingly, the Board finds that the preponderance of the evidence is against the assignment of a rating in excess of 10 percent for a lumbar spine disability prior to December 7, 2011, and the claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 2. Entitlement to a rating in excess of 20 percent for a lumbar spine disability between December 7, 2011 and April 7, 2015. At a December 2011 VA examination, the Veteran reported no flare-ups. An examination of the thoracolumbar spine found forward flexion to 40 degrees, extension to 10 degrees, right and left lateral flexion to 10 degrees, and right and left lateral rotation to 10 degrees. All movements had end of range pain, but no decrease in range of motion due to pain following repetitive testing. The examiner noted functional loss after repetitive use in the form of disturbance in locomotion; interference with sitting, standing, and weight-bearing; and limitations lifting. The examiner found no localized tenderness or pain to palpation of the joint or associated soft tissues. There was no evidence of muscle atrophy. Muscle strength reflex and sensory examinations were all within normal limits. The examiner found IVDS, with no incapacitating episodes within the prior 12 months. The examiner noted constant use of a walker. The examiner diagnosed degenerative disc disease of the thoracolumbar spine. March 2012 VA medical records indicate that the Veteran was referred for increased balance difficulty due to cerebellar ataxia. No mention of the back was made. VA medical records from August 2012 through September 2013 indicate continued complaints of lower back pain. On examination during this time, there was tenderness at the bilateral lumbar paraspinal muscles, with mild spasm. Examiners noted abnormal flexion and extension, but did not specify degrees. At a June 2014 VA examination, the Veteran reported he used a walker at home and a wheelchair when he was away from home. The Veteran did not report any flare-ups. An examination of the thoracolumbar spine found forward flexion of 40 degrees with pain, extension to 15 degrees, with pain beginning at 10 degrees, right and left lateral flexion to 15 degrees with pain, and right and lateral rotation to 15 degrees with pain. The Veteran was unable to perform repetitive testing due to weak lower extremities and unsteady gait. The examiner noted tenderness or pain to palpation in the lumbar spine. There examiner also noted muscle spasm, which did not result in abnormal gait or abnormal spinal contour. There was no evidence of guarding. There was no ankylosis of the spine. The examiner noted functional impact in the form of not being able to stand or sit for prolonged periods of time. Subsequent VA medical records indicate the Veteran was seen for management of chronic pain. During this time, the Veteran reported non-radiating pain the lower back. The Veteran reported that physical activity and long walks aggravated the pain. On examination, spinal curvature was found to be normal. There was tenderness at the lumbosacral paraspinal muscles. The examiner noted abnormal flexion and extension, but did not specify degrees. The Veteran’s gait was noted as antalgic, with his wife pushing him on a wheelchair. The Board finds that a rating in excess of 20 percent for a lumbar spine disability during this period is not warranted. VA examinations show that the lumbar spine disability was manifested by forward flexion greater than 30 degrees, but not greater than 60 degrees within this period. The Veteran’s reports of pain and functional loss are adequately considered by the VA examination reports and findings of motion limitation. There is no evidence of forward flexion of the thoracolumbar spine 30 degrees or less, or of favorable ankylosis of the entire thoracolumbar spine, even considering other functionally limiting factors. The Board notes that the Veteran was unable to perform repetitive testing at the June 2014 VA examination due to balance, but the evidence of record indicates this was due to cerebellar ataxia. Therefore, a rating in excess of 20 percent is not warranted. The Board has considered whether the application of another diagnostic code may enable a higher rating, including Diagnostic Code 5003 for degenerative arthritis. However, after review, the Board finds that no other diagnostic code provides for a higher or separate rating. 38 C.F.R. §§ 4.3, 4.7, 4.71(a). Further, there is no evidence of incapacitating episodes resulting from intervertebral disc syndrome, and thus a higher rating cannot be assigned using the criteria for rating intervertebral disc syndrome. 38 C.F.R. § 4.71a, Diagnostic Code 5243. In making a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which is found to be persuasive or unpersuasive, and provide the reasons for the rejection of any material evidence favorable to the claimant. Gabrielson v. Brown, 7 Vet. App. 36 (1994); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The Veteran is competent to report symptoms, such as pain, because that requires only personal knowledge as it comes to him through his senses. Layno v. Brown, 6 Vet. App. 465 (1994). However, the objective evidence does not demonstrate symptoms that more nearly approximate a higher rating under the schedule of ratings for the musculoskeletal system during this period. Accordingly, the Board finds that the preponderance of the evidence is against the assignment of a rating in excess of 20 percent for a lumbar spine disability between December 7, 2011 and April 7, 2015, and the claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 3. Entitlement to a rating in excess of 40 percent for a lumbar spine disability as of April 7, 2015. At a June 2015 VA examination, the Veteran reported he could not do much, and had to use a wheelchair regularly. The examiner noted that the Veteran used a wheelchair on a consistent basis for the low back condition. The Veteran reported flare-ups. The examination was not performed during a flare-up. The examiner found that the examination was medically consistent with the Veteran’s statements describing functional loss during a flare-up. The examiner found that pain, weakness, fatigability, or incoordination did not significantly limit functional ability during a flare-up. An examination of the thoracolumbar spine found forward flexion to 30 degrees, extension to 10 degrees, right and lateral flexion to 15 degrees, right lateral rotation to 10 degrees, and left lateral rotation to 15 degrees. There was evidence of pain on all movements. The examiner indicated that range of motion itself contributed to the functional loss in the form of limiting bending, stooping, lifting, and the ability to bear weight for prolonged periods of time. The Veteran was able to perform repetitive testing, and the examiner found no additional loss of function or range of motion after repetitive testing. There was evidence of guarding resulting in abnormal gait or abnormal spinal contour. There was no evidence of muscle atrophy, or ankylosis. The examiner noted that the Veteran had instability of station, disturbance of locomotion, and interference with sitting and standing. The examiner diagnosed degenerative disc disease of the lumbar spine. August 2016 VA medical records for pain management indicate that the Veteran reported pain in the lower back bilaterally, aggravated by walking or standing. The Veteran reported increased issues with balance. Imaging found degenerative disc disease, and degenerative posterior element sclerosis. An examination of the thoracolumbar spine found loss of lumbar curvature. The examiner noted abnormal flexion and extension, but did not provide degrees. There was no tenderness over the thoracic spine. The examiner found antalgic gait, and noted that the Veteran used a scooter to ambulate. At a March 2017 VA examination, the Veteran could not perform range of motion testing because he was bound to a wheelchair after recently suffering a brain stem stroke. The Veteran reported daily flare-ups. He stated he had no pain while sitting in the wheelchair, but experienced pain when he stood up. The Veteran reported that he stopped attempting to walk because of weakness and repeated falls. The examiner found normal muscle strength and reflexes. There was no pain to palpation. There was no evidence of ankylosis of the spine. The examiner noted that the Veteran had a brain stem infarct that caused dizziness and weakness, and that the Veteran had a history of seizure disorder. The examiner found he was confined to a wheelchair due to these problems. The Board finds that a rating in excess of 40 percent for a lumbar spine disability as of April 7, 2015, is not warranted. VA examinations show that the lumbar spine disability has been manifested by forward flexion of 30 degrees or less. The Veteran’s reports of pain and functional loss are adequately considered by the VA examination reports and findings of motion limitation. There is no evidence of unfavorable ankylosis of the entire thoracolumbar spine, even considering other functionally limiting factors. While the Veteran was unable to perform range of motion testing at the most recent VA examination, the evidence indicates that was due to cerebellar ataxia and stroke. Therefore, a rating in excess of 40 percent is not warranted. The Board has considered whether the application of another diagnostic code may enable a higher rating, including Diagnostic Code 5003 for degenerative arthritis. However, after review, the Board finds that no other diagnostic code provides for a higher or separate rating. 38 C.F.R. §§ 4.3, 4.7, 4.71(a). Further, there is no evidence of incapacitating episodes resulting from intervertebral disc syndrome, and thus a higher rating cannot be assigned using the criteria for rating intervertebral disc syndrome. 38 C.F.R. § 4.71a, Diagnostic Code 5243. In making a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which is found to be persuasive or unpersuasive, and provide the reasons for the rejection of any material evidence favorable to the claimant. Gabrielson v. Brown, 7 Vet. App. 36 (1994); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The Veteran is competent to report symptoms, such as pain, because that requires only personal knowledge as it comes to him through his senses. Layno v. Brown, 6 Vet. App. 465 (1994). However, the objective evidence does not demonstrate symptoms that more nearly approximate a higher rating under the schedule of ratings for the musculoskeletal system during this period. Accordingly, the Board finds that the preponderance of the evidence is against the assignment of a rating in excess of 40 percent for a lumbar spine disability between December 7, 2011 and April 7, 2015, and the claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). REASONS FOR REMAND 1. Entitlement to TDIU is remanded. The Board finds that the issue of entitlement to a total rating for compensation purposes based on individual unemployability due to service-connected disabilities has been raised by the record. Rice v. Shinseki, 22 Vet. App. 447 (2009). At an August 2013 hearing, the Veteran’s representative stated that the Veteran stopped working due to service-connected disabilities. Palczewski v. Nicholson, 21 Vet. App. 174 (2007). Therefore, remand is necessary to obtain a medical opinion regarding the impact of all service-connected disabilities on the Veteran’s ability to obtain and maintain employment. The matter is REMANDED for the following action: Schedule the Veteran for a VA examination with an appropriate medical doctor examiner. The examiner should describe the symptoms and effects of all of the service-connected disabilities on employment. The examiner should opine as to whether, without regard to the Veteran’s age or the impact of any nonservice-connected disabilities, it is at least as likely as not (50 percent probability or greater) that the service-connected disabilities, either separately or in combination, make the Veteran unable to secure or follow a substantially gainful occupation consistent with his education and occupational experience. If the Veteran is felt capable of work, the examiner should state what type of work and what accommodations would be necessary due to the service-connected disabilities. The examiner should set forth the complete rationale for all opinions expressed and conclusions reached. Harvey P. Roberts Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD H. Ahmad, Associate Counsel