Citation Nr: 19190829 Decision Date: 12/03/19 Archive Date: 12/03/19 DOCKET NO. 16-19 863 DATE: December 3, 2019 ORDER A 30 percent rating, but no higher, prior to August 14, 2015 for stool incontinence is granted. A rating in excess of 30 percent from August 14, 2015 for stool incontinence is denied. A compensable for erectile dysfunction is denied. A compensable rating prior to August 14, 2015 for urinary incontinence is denied. A rating greater than 40 percent from August 14, 2015 for urinary incontinence is denied. REMANDED Entitlement to service connection for hypertension, claimed as secondary to service-connected lumbar spine disability, is remanded. Entitlement to a rating in excess of 40 percent thoracolumbar spine disability (back disability) is remanded. Entitlement to a rating in excess of 20 percent prior to August 14, 2015 and in excess of 40 percent therefrom for right lower extremity (RLE) radiculopathy of the sciatic nerve. FINDINGS OF FACT 1. Prior to August 15, 2015, resolving all reasonable doubt in favor of the Veteran, his stool incontinence resulted in occasional involuntary bowel movements, necessitating wearing of a pad, but not extensive leakage and fairly frequent involuntary bowel movements. 2. From August 15, 2015, the Veteran’s stool incontinence was not more nearly manifested by extensive leakage and fairly frequent involuntary bowel movements. 3. At no point during the appeal period has the Veteran’s erectile dysfunction been manifested by penile deformity. 4. Prior to August 14, 2015, the preponderance of the evidence is against a finding that the Veteran’s urinary incontinence disability caused urine leakage requiring the use of absorbent materials, increased urinary frequency, or caused obstructed voiding. 5. From August 14, 2015, the preponderance of the evidence is against a finding that the Veteran’s urinary incontinence disability caused urine leakage requiring the use of absorbent materials more than 4 times per day or requiring the use of an appliance. CONCLUSIONS OF LAW 1. The criteria for a 30 percent rating, but no higher, prior to August 14, 2015 for stool incontinence are met. 38 U.S.C.§§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.114, Diagnostic Code 7332. 2. The criteria for a rating in excess of 30 percent from August 14, 2015 for stool incontinence are not met. 38 U.S.C.§§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.114, Diagnostic Code 7332. 3. The criteria for a rating in excess of 0 percent for erectile dysfunction have not been met. 38 U.S.C.§§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.115b, Diagnostic Code 7522. 4. The criteria for a compensable rating prior to August 14, 2015 for urinary incontinence have not been met. 38 U.S.C.§§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.115a, 4.115b, Diagnostic Code 7542. 5. The criteria for a rating in excess of 40 percent from August 14, 2015 for urinary incontinence have not been met. 38 U.S.C.§§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.115a, 4.115b, Diagnostic Code 7542. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 1987 to August 1990 and from June 1994 to June 1997. The Board notes that the Veteran was previously represented by a private attorney. In an October 2015 letter, that attorney withdrew from representation. 38 C.F.R. § 20.608 (b)(2). The Veteran has not objected to the attorney’s withdrawal of representation. The Board afforded the Veteran another opportunity to appoint representation. He has not done so. Hence, he is unrepresented before the Board in this appeal. Increased Rating Disability evaluations are determined by the application of the VA Schedule for Rating Disabilities (Rating Schedule). 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 military service and their residual conditions in civil occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Any reasonable doubt regarding the degree of disability will be resolved in favor of the claimant. 38 C.F.R. § 4.3. If two evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that evaluation; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. A disability may require re-evaluation in accordance with changes in a veteran’s condition. It is thus essential, in determining the level of current impairment, that the disability be considered in the context of the entire recorded history. 38 C.F.R. § 4.1. 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). 1. Entitlement to a rating in excess of 10 percent prior to August 14, 2015 and in excess of 30 percent therefrom for stool incontinence. The present claim for increased rating arises from an initial grant of service connection for stool incontinence secondary to spinal cord compression, rated 10 percent effective June 4, 2010, and increased to 30 percent effective August 14, 2015. The Veteran contends that the ratings for the disability do not adequately compensate the severity of the disability. The Veteran’s stool incontinence disability is rated under Diagnostic Code 7332 for impairment of sphincter control. Under Diagnostic Code 7332, a 0 percent evaluation is assigned for slight symptomology without leakage; a 10 percent rating is assigned for constant slight, or occasional moderate leakage; a 30 percent rating is assigned for occasional involuntary bowel movements, necessitating wearing of pad; a 60 percent rating is assigned for extensive leakage and fairly frequent involuntary bowel movements; and a 100 percent rating is assigned for complete loss of sphincter control. 38 C.F.R. § 4.114, Diagnostic Code 7332. The Board concludes that, prior to August 15, 2015, resolving all reasonable doubt in favor of the Veteran, his stool incontinence resulted in occasional involuntary bowel movements, necessitating wearing of a pad, but not extensive leakage and fairly frequent involuntary bowel movements. However, the Board further concludes that, from August 15, 2015, the preponderance of the evidence is against finding that the Veteran’s stool incontinence more nearly was manifested by extensive leakage and fairly frequent involuntary bowel movements. 38 U.S.C.§§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.114, Diagnostic Code 7332. A November 2011 VA examination of the spine reflects that the Veteran reported intermittent loss of control of stool. The examiner noted neurologic abnormalities in the form of bladder and bowel symptoms. Similarly, a February 2012 VA examination for intestinal conditions reflects the presence of diagnosed episodic stool incontinence. The Veteran reported intermittent loss of control of stool and urine. The Veteran had experienced involuntary defecation approximately 15 to 20 times over the previous 2 years. He reported he had to carry extra clothing and wipes with him when he left the home. The Veteran slept on a pad at night. On examination, the examiner found rectal tone was slightly diminished. An August 2015 VA examination for intestinal conditions reflects that the Veteran reported ongoing and worsening issues with stool incontinence and nocturnal micturition. He stated that he experienced stool incontinence 2 to 3 times per month and at least some daily fecal leakage. The examiner noted constant slight leakage and occasional involuntary bowel movements. On examination, anal tone was lax. VA medical records during the appeal period show consistent and continuous complaints of episodic stool incontinence. The Veteran described urgency, with an inability to control movements. Resolving all reasonable doubt in favor of the Veteran, the Board finds that a 30 percent rating for stool incontinence is warranted during the entire appeal period. However, the schedular criteria for a higher rating are not more nearly met. Neither the lay nor the medical evidence reflects that the Veteran’s disability is more nearly manifested by extensive leakage and fairly frequent involuntary bowel movements. Accordingly, the Board finds that a 30 percent rating for stool incontinence is warranted during the entire appeal period. However, the preponderance of the evidence is against the assignment of a rating in excess of 30 percent for stool incontinence at any time during the appeal period. 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 2. Entitlement to a compensable rating for erectile dysfunction. The Veteran seeks a compensable rating for erectile dysfunction. His erectile dysfunction is rated pursuant to Diagnostic Code 7522. Under Diagnostic Code 7522, a 20 percent rating is assigned for a penis deformity with loss of erectile power. A 0 percent rating is assigned where the criteria for a compensable rating are not met. 38 C.F.R. § 4,115b, Diagnostic Code 7522. The Board concludes that the preponderance of the evidence is against finding that the Veteran’s erectile dysfunction has been more nearly manifested by penile deformity. 38 U.S.C.§§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.115b, Diagnostic Code 7522. VA examinations dated in February 2012, September 2012, and August 2015 reflect that the Veteran has had problems with erectile dysfunction unimproved with medication. However, objectively, the penis, testes, and epididymis were normal. The Veteran does not claim a penis deformity, nor do the medical records show complaint, diagnosis or treatment for a penis deformity. All VA examinations found no penile deformity. Neither the lay nor medical evidence shows the presence of any penis deformity. On balance, the weight of the evidence is against the claim for increase. Accordingly, the claim is denied. There is no doubt to resolve. 38 U.S.C. § 5107(b). 3. Entitlement to a compensable rating prior to August 14, 2015 and in excess of 40 percent therefrom for urinary incontinence. The Veteran contends that higher ratings are warranted for his urinary incontinence. The present claim arises from an initial grant of service connection for urinary incontinence secondary to spinal cord compression, rated 0 percent prior to August 14, 2015, and increased to 40 percent as of August 14, 2015. The Veteran's urinary incontinence is rated under Diagnostic Code 7542, which is rated as a voiding dysfunction. 38 C.F.R. §§ 4.115a, 4.115b. Voiding dysfunction is rated as urine leakage, frequency, or obstructed voiding. 38 C.F.R. §§ 4.115a, 4.115b. Voiding dysfunction is rated based on urine leakage, urinary frequency, or obstructed voiding. For urine leakage, a 20 percent rating is assigned for leakage requiring the wearing of absorbent materials, which must be changed less than two times per day. A 40 percent rating is assigned for leakage requiring the wearing of absorbent materials, which must be changed two to four times per day. A 60 percent rating is assigned for the use of an appliance or for wearing absorbent materials that must be changed more than four times per day. For urinary frequency, a 10 percent rating is warranted for a daytime voiding interval between two and three hours, or awakening to void two times per night. A 20 percent rating is warranted for a daytime voiding interval between one and two hours, or awakening to void three to four times per night. A 40 percent rating is warranted for a daytime voiding interval of less than one hour, or awakening to void five or more times per night. For obstructed voiding, a 0 percent rating is assigned for obstructive symptomatology with or without stricture disease requiring dilatation one to two times per year. A 10 percent rating is assigned for marked obstructive symptomatology (hesitancy, slow or weak stream, decreased force of stream) with any one or combination of the following: (1) post- void residuals greater than 150 cubic centimeters (cc’s); (2) uroflowmetry; markedly diminished peak flow rate (less than 10 cc’s per second); (3) recurrent urinary tract infections secondary to obstruction; (4) stricture disease requiring periodic dilatation every two to three months. A 30 percent rating is assigned for urinary retention requiring intermittent or continuous catheterization. The Board concludes that, prior to August 14, 2015, the preponderance of the evidence is against a finding that the Veteran’s urinary incontinence disability was more nearly manifested by urine leakage requiring the use of absorbent materials, increased urinary frequency, or caused obstructed voiding. The Board further concludes that, from August 14, 2015, the preponderance of the evidence is against a finding that his disability was more nearly manifested by urine leakage requiring the use of absorbent materials more than 4 times per day or requiring the use of an appliance. At the outset, the Board notes that there is no evidence in the record that the Veteran experiences symptomology of obstructed voiding. VA treatment records dated from May 2010 through August 2010 reflect that the Veteran reported episodes of urinary incontinence and an inability to control the bladder. A September 2010 note reflects that he reported he was able to control urination. An October 2010 note reflects that he denied nocturia, frequency, hesitation, or incomplete emptying. A January 2011 note shows that he reported no bladder dysfunction. The record reflects that the Veteran experienced nocturnal urinary incontinence in April 2011 following his March 2011 back surgery. A May 2011 note reflects that the Veteran denied further nocturnal urinary incontinence. A November 2011 VA examination for the spine reflects that the Veteran reported intermittent loss of control of urine. The Veteran approximated that he experienced urinary incontinence approximately 6 times in the past year and a half. A February 2012 VA examination reflects that the Veteran reported intermittent loss of control of urine. He stated he experienced urinary incontinence approximately 12 times over the prior 2 years. The Veteran reported he had to carry a bottle with him when driving, and that he avoided drinking fluids in the evening. The Veteran also stated he slept on a pad. The examiner noted a voiding dysfunction which caused urine leakage. The urine leakage did not require the wearing of absorbent material. The voiding dysfunction did not cause an increase in urinary frequency or symptoms of obstructed voiding. A September 2012 VA examination reflects that the Veteran reported loss of urine control at night, occurring twice a month. He also reported marked urgency during the day. The examiner noted a voiding dysfunction which caused urine leakage. The examiner did not indicate if the voiding dysfunction required the use of absorbent materials. The voiding dysfunction did not require the use of an appliance; did not cause increased urinary frequency; and did not cause signs or symptoms of obstructed voiding. An August 2015 VA examination reflects that the Veteran reported ongoing and worsening issues with urinary incontinence with frequent loss of nocturnal control. He stated that he experienced urinary incontinence 5 to 6 times a night, and 6 to 7 times a day. The examiner noted a voiding dysfunction, which caused urine leakage. The leakage required the use of absorbent materials that had to be changed 2 to 4 times per day. The dysfunction also caused increased urinary frequency, with a daytime voiding interval of between 1 to 2 hours, and nighttime awakening to void 5 or more times per night. The dysfunction did not cause the use of an appliance, or signs or symptoms of obstructed voiding. Neither the lay nor the medical evidence reflects that prior to August 14, 2015 the the Veteran’s voiding dysfunction manifested with urinary leakage requiring the use of absorbent material; increased urinary frequency; or obstructed voiding. Whereas, the record establishes as of August 14, 2015, he experienced urinary leakage requiring the use of absorbent materials that needed to be changed 2 to 4 times per day. The evidence indicates that the Veteran’s voiding dysfunction does not require the wearing of absorbent materials that need to be changed more than 4 times per day, nor does it require the use of an appliance. The schedular criteria for a higher rating prior to or since August 14, 2015 are not more nearly met at any time during the appeal. Accordingly, the claim for increase is denied. There is no doubt to resolve. 38 U.S.C. § 5107(b). REASONS FOR REMAND 1. Entitlement to service connection for hypertension is remanded. The Veteran asserts that hypertension is secondary to his back pain associated with his service-connected back disability. Except as provided in 38 C.F.R. § 3.300(c), disability which is proximately due to or the result of a service-connected disease or injury shall be service connected. 38 C.F.R. § 3.310. This includes any increase in disability (aggravation). Service connection can be granted for disability that is aggravated by a service-connected disability and that compensation can be paid for any additional impairment resulting from the service-connected disease or injury. Allen v. Brown, 7 Vet. App. 439 (1995) (en banc). When aggravation of a veteran’s non- service-connected condition is proximately due to or the result of a service-connected condition, such veteran shall be compensated for the degree of disability over and above the degree of disability existing prior to the aggravation. Allen, supra. Service treatment records (STRs) reflect no findings for hypertension. Hypertension is first documented in June 2010 VA treatment records, which show a diagnosis of new onset hypertension. A September 2012 VA examination reflects that the Veteran reported the onset of hypertension in 2009. The Veteran reported decreased mobility resulting in weight gain after a December 2009 assault, in addition to significant stress. The Veteran was on continuous medication for hypertension. Current blood pressure readings were 131/85, 123/84, and 113/77. The examiner noted that a diagnosis of hypertension was entered into the Veteran’s VA medical records in October 2010. The provider at that time indicated a high-salt diet may have been causal. The examiner opined that it was less likely than not that the Veteran’s hypertension was caused or aggravated by service-connected back disabilities because there was no relationship between hypertension and back conditions. The 2012 VA medical opinion does not include a complete rationale for the conclusion that hypertension is not secondary to service-connected back disability. It is noted that a medical opinion must support the conclusions reached with an analysis that is adequate for the Board to consider and weigh against other evidence of record. See Stefl v. Nicholson, 21 Vet. App. 102, 124-25. Also, “[A] medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two.” Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). Therefore, to ensure VA has met its duty to assist, remand is necessary. 2. Entitlement to a rating in excess of 40 percent for back disability is remanded. The Veteran contends that his back disability is sufficiently severe to warrant the assignment of a rating higher than 40 percent. This appeal arises from an initial grant of service connection for spinal cord compression with degenerative disc disease of the thoracolumbar spine, rated 40 percent effective June 4, 2010. In March 2011, the Veteran underwent L4-5 posterior fusion. The Board notes that the Veteran was assigned a 100 percent total convalescence rating for the period from March 16, 2011 through May 1, 2011. May 2010 Social Security Administration records show complaints of constant lower back pain, radiating to the right thigh. The Veteran rated the pain an 8 out of 10. On examination, there was tenderness of the paraspinal muscles from T1 to L5. Straight leg tests were positive at 15 degrees, bilaterally. VA medical records from June 2010 through March 2011 show consistent complaints of lower back pain, which radiated down the lower extremities. During this time, the Veteran reported episodes of urinary and stool incontinence. Examinations during this period found lower back tenderness at the paraspinal muscles. An MRI of the spine in September 2010 found anterolisthesis of L4 over L5 with associated bilateral spondylosis, resulting in stenosis of the lateral recesses and neuroforamina; and multilevel disc protrusion. April 2011 Social Security Administration records indicate the Veteran complained of constant back pain. The Veteran reported difficulty lifting, bending and stooping. He also reported that prolonged walking or sitting aggravated back pain. Examination of the thoracolumbar spine found forward flexion to 75 degrees and extension to 0 degrees. Left and right lateral flexion was to 30 degrees. At a November 2011 VA examination, the Veteran reported persistent, severe pain in the lower back that radiated down the left leg to the calf level, posteriorly. The Veteran reported flare-ups occur up to once a week, and typically lasted about 3 days—he remained indoors and was unable to do much more than basic functioning. The Veteran constantly used a cane. There was forward flexion to 10 degrees; extension to 0 degrees; right and left lateral flexion to 10 degrees; and right and left lateral rotation to 20 degrees. There was objective evidence of pain on all motion. The Veteran was able to perform repetitive use testing with no additional loss of range of motion. Functional impairment after repetitive use took the form of weakened movement, pain on movement, disturbance of locomotion, and interference with sitting, standing, and/or weight-bearing. January 2012 VA medical records indicate the Veteran reported pain in the lower back and findings for thoracolumbar forward flexion to 30 degrees and extension to 15 degrees. Back pain was exacerbated by flexion, extension, and facet loading maneuvers. May 2012 VA medical records, lumbar flexion and extension were found to be limited by 50 percent due to pain. June 2012 VA medical records reflect thoracolumbar flexion to 75 degrees with pain and extension to 10 degrees with pain. A September 2012 VA examination, the Veteran reported pain in the lower back radiating into the legs, bilaterally, rated a 5 out of 10 with treatment. The Veteran was markedly limited in all bending, lifting, and carrying. He stated he experienced flare-ups about every month or two, lasting 3 days, during which the Veteran is confined to the house and can only move between a recliner and the bathroom. There was thoracolumbar spine forward flexion to 20 degrees, with pain beginning at 10 degrees; extension to 5 degrees; right lateral flexion to 10 degrees; left lateral flexion to 15 degrees; and right and left lateral rotation to 15 degrees. There was objective evidence of pain on all motion. The Veteran was able to perform repetitive-use testing without additional loss of range of motion, but with evidence of less movement than normal, weakened movement, pain on movement, disturbance of locomotion, and interference with sitting, standing and/or weight-bearing. In April 2015, the Veteran underwent decompressive laminectomy at L1-2, and left discectomy at L1-2 and L2-3. An August 2015 VA examination reflects complaints of chronic lower back pain, somewhat better since the April 2015 surgery. The Veteran reported flare-ups. Objectively, for the thoracolumbar spine, there was forward flexion to 10 degrees; extension to 0 degrees; right and left lateral flexion to 10 degrees; and right and left lateral rotation to 10 degrees. There was pain noted on exam, which caused functional loss. There was also evidence of pain with weight-bearing. Pain, fatigue, weakness, and lack of endurance significantly limited functional ability with repeated use over time. There was no evidence of ankylosis. Having carefully reviewed the record, the Board finds that remand is necessary as there appears to be relevant outstanding treament records and because the examinations of record do not adequately reflect the additional functional loss expereinced durign flare-ups to include whether it is the functional equivalent of unfavorable ankylosis of the entire thoracolumbar spine. Sharp v. Shulkin, 29 Vet. App. 26, 34-36 (2017). To ensure that VA has met its duty to assist, remand is necessary. 3. Entitlement to a rating in excess of 20 percent prior to August 14, 2015 and in excess of 40 percent therefrom for RLE radiculopathy of the sciatic nerve. The Veteran contends that a higher rating is warranted for RLE radiculopathy. Paralysis of the sciatic nerve is evaluated in accordance with the criteria set forth in 38 C.F.R. § 4.124a, Diagnostic Code 8520. (Neuritis and neuralgia of that group are evaluated under Diagnostic Codes 8620 and 8720.). Under these criteria, mild incomplete paralysis is rated as 10 percent disabling. Moderate incomplete paralysis is rated as 20 percent disabling. Moderately severe incomplete paralysis is rated as 40 percent disabling. Severe incomplete paralysis, with marked muscular atrophy is rated as 60 percent disabling. Complete paralysis, with the foot dangles and drops, no active movement possible of muscles below the knee, flexion of knee weakened or (very rarely) lost is rated as 80 percent disabling. 38 C.F.R. § 4.124a. Medical records from VA and the Social Security Administration records show complaints of RLE pain, tremors/shaking, numbness, and weakness of all extremities. There were findings for weakness, sensory changes, and hyperreflexia in all four extremities. A September 2010 note shows normal muscle strength and sensation to light touch and pinprick intact; reflexes were hyperactive with clonus in the lower extremities. A November 2011 VA spine examination reflects moderate radicular symptoms in the right leg, involving the sciatic nerve. Specifically, there was normal muscle strength; no muscle atrophy; normal deep tendon reflexes; and RLE decreased sensation to light touch. A February 2012 VA examination reflects RLE severe constant pain and numbness along with decreased light touch sensation. However, there was normal muscle strength, no muscle atrophy, and normal deep tendon reflexes. In a June 2012 VA medical record, the Veteran reported numbness and weakness in the right lower extremity, with the right foot dragging at times when he walked. In July 2012, the Veteran presented to the Emergency Room complaining of right leg pain and weakness. The Veteran reported that he experienced a squeezing pain and that the right leg began jerking. The examiner assessed probable lumbar radiculopathy. An August 2012 VA EMG found no significant evidence of right leg neuropathy. A September 2012 VA spine examination reflects moderate RLE constant pain, involving the sciatic nerve. Specifically, although RLE deep tendon reflexes were absent at the right knee and hyperactive with clonus at the right ankle, and there was decreased sensation to light touch, muscle strength testing found active movement against some resistance and no muscle atrophy. An August 2015 VA examination reflects severe RLE radiculopathy. The Veteran reported lower back pain that radiated down both legs. On examination, muscle strength testing found active movement against gravity in right hip flexion; and active movement against some resistance in right knee extension, ankle plantar flexion, ankle dorsiflexion, and great toe extension. There was no muscle atrophy. Deep tendon reflexes were absent in the right knee, and hyperactive with clonus in the right ankle. Sensory examination found decreased sensation to light touch in the right lower leg/ankle and right foot/toes. The examiner found presence of radiculopathy in the form of moderate constant pain, severe paresthesias and/or dysesthesias, and severe numbness in the RLE. Both the femoral nerve and sciatic nerve roots were involved. The Board finds that the medical evidence is inadequate to evaluate the Veteran’s RLE radiculopathy during the appeal period. The words “mild,” “moderate,” “moderately severe,” and “severe” as used in the various Diagnostic Codes are not defined in the Rating Schedule. However, regulations provide that ratings for peripheral neurological disorders are to be assigned based the relative impairment of motor function, trophic changes, or sensory disturbance. 38 C.F.R. § 4.120. Consideration is also given for loss of reflexes, pain, and muscle atrophy. See 38 C.F.R. §§ 4.123, 4.124. A retrospective medical opinion is necessary to address the level of impairment prior to August 14, 2015 and after August 14, 2015 with consideration of these factors after review of the relevant treatment records and a current examination of the RLE peripheral nerves. Also, the VA examinations of record do not comply with the requirements in Sharp v. Shulkin, 29 Vet. App. 26, 34-36 (2017) (An examiner must attempt to elicit relevant information regarding the description of flare-ups and any additional functional loss suffered during flare-ups). Lastly, the originating agency should address whether a separate disability rating is warranted for RLE femoral nerve involvement based on the August 2015 VA examination findings. To ensure that VA has met its duty to assist, remand is necessary. Accordingly, the matter is REMANDED for the following action: 1. Obtain the Veteran’s VA treatment records for the period from April 2016 to the Present. 2. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected thoracolumbar spine disability. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran’s disability under the rating criteria. In so doing, the examiner must attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. To the extent possible, indicate whether during flare-ups there is lost range of motion that is the functional equivalent of unfavorable ankylosis of the entire thoracolumbar spine and, if yes, from what date this shown. If it is not possible to provide a specific measurement based on direct observation, the examiner should provide an estimate, if at all possible, of the additional impairment due to flare-ups based on the other evidence of record and the Veteran’s statements. If it is not possible to provide a specific measurement without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training).] 3. Schedule the Veteran for an examination by an appropriate clinician to determine the severity of his RLE radiculopathy of the sciatic nerve and femoral nerve. The examiner should provide a full description of the RLE radiculopathy disability and report all signs and symptoms necessary for evaluating the Veteran’s disability under the rating criteria. (a.) Flare-ups: Attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. If it is not possible to provide a specific measurement based on direct observation, the examiner should provide an estimate, if at all possible, of the additional impairment due to flare-ups based on the other evidence of record and the Veteran’s statements. If it is not possible to provide a specific measurement without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). (b.) To the extent feasible, the examiner should identify the level(s) of impairment (mild, moderate, moderately severe, severe, or complete) due to RLE radiculopathy during the appeal period (June 2010 to date), which may vary throughout the appeal period depending on symptoms and clinical finding, with consideration of the relative impairment of motor function, trophic changes, or sensory disturbance after review of the relevant treatment records and a current examination of the RLE peripheral nerves. 4. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s hypertension is at least as likely as not (a) proximately due to service-connected back disability and/or (b) aggravated (worsened) beyond its natural progression by service-connected back disability. It is noted that the aggravation need not be permanent in nature. A complete rationale is required for (a) and (b). The medical opinion must support the conclusions reached with an analysis that is adequate for the Board to consider and weigh against other evidence of record; medical opinions must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. If an opinion cannot be expressed without resort to speculation, the clinician must indicate so and discusse why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. 5. Consider whether a separate disability rating is warranted for RLE radiculopathy with femoral nerve involvement based on the August 2015 VA examination findings for femoral nerve involvement. C.A. SKOW Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board H. Ahmad, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.