Citation Nr: 19166263 Decision Date: 08/27/19 Archive Date: 08/27/19 DOCKET NO. 14-38 179A DATE: August 27, 2019 ORDER Entitlement to an increased disability rating for degenerative disc disease of the lumbar spine (lumbar spine DDD), rated as 20 percent disabling prior to February 26, 2019, is granted. Entitlement to an increased disability rating for lumbar spine DDD, rated as 40 percent on and after February 26, 2019, is denied. Entitlement to an increased disability rating for left lower extremity radiculopathy, rated as 10 percent disabling prior to September 27, 2014, and rated as 20 percent disabling on and after September 27, 2014, is denied. REMANDED Entitlement to a separate evaluation for neurological bladder impairment as part of the Veteran’s service-connected lumbar spine DDD. Prior to February 26, 2019, entitlement to a separate evaluation for right lower extremity radiculopathy as part of the Veteran’s service-connected lumbar spine DDD. FINDINGS OF FACT 1. Prior to February 26, 2019, lumbar spine DDD is more nearly approximated by 30 degrees of flexion, but not ankylosis. 2. On and after February 26, 2019, lumbar spine DDD is not productive of ankylosis. 3. Prior to September 27, 2014, the Veteran’s left lower extremity radiculopathy most nearly approximates mild incomplete paralysis. 4. On and after September 27, 2014, the Veteran’s left lower extremity most nearly approximates moderately severe incomplete paralysis. CONCLUSIONS OF LAW 1. Resolving all doubt in favor of the Veteran, the criteria for a 40 percent rating, but no higher, prior to February 26, 2019 for lumbar spine DDD are met. 38 U.S.C. §§ 1155, 5107 (2018); 38 C.F.R. § §§ 4.7, 4.124a, Diagnostic Code 5237 – 5243 (2018). 2. The criteria for a rating in excess 40 percent on and after February 26, 2019 for lumbar spine DDD have not been met. 38 U.S.C. §§ 1155, 5107 (2018); 38 C.F.R. § §§ 4.7, 4.124a, Diagnostic Code 5237 – 5243 (2018). 3. Prior to September 27, 2014, the criteria for a rating in excess of 10 percent for the left lower extremity radiculopathy are not met. 38 U.S.C. §§ 1155, 5107 (2018); 38 C.F.R. § §§ 4.7, 4.124a, Diagnostic Code 8626 (2018). 4. On and after September 27, 2014, the criteria for a rating in excess of 20 percent for left lower extremity radiculopathy are not met. 38 U.S.C. §§ 1155, 5107 (2018); 38 C.F.R. § §§ 4.7, 4.124a, Diagnostic Code 8626 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 1981 to October 1983 and from January 1986 to May 1989. This case comes before the Board of Veterans’ Appeals (the Board) on appeal from rating decisions of the by the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran filed a claim in October 2011 that the RO interpreted as increased evaluation claims. In an August 2013 rating decision, the RO denied an increased evaluation for the lumbar spine DDD. The Veteran filed an August 2013 notice of disagreement and in November 2014 the RO issued a statement of the case. That same month, the Veteran filed a substantive appeal. In a November 2014 rating decision, the RO assigned an increased 20 percent evaluation for the left lower extremity radiculopathy, effective September 27, 2014. These issues were before the Board in 2018, when the Board remanded for additional examinations. In an April 2019 rating decision, the RO assigned the lumbar spine DDD a 40 percent evaluation, effective February 26, 2019. Additionally, a separate evaluation for right lower extremity radiculopathy was granted, effective February 26, 2019. Thus, the issues are as listed above. The Board finds that there was substantial compliance with its prior remand instructions. D’Aries v. Peake, 22 Vet. App. 97, 105 (2008). The October 2018 Board remand directed that outstanding VA records be obtained and that a VA examination be obtained. As such has been accomplished, compliance with the prior remand has been accomplished. Because the RO did not assign the maximum disability ratings possible the appeals for higher disability evaluations remain before the Board. AB v. Brown, 6 Vet. App. 35 (1993). Duty to Notify and Assist Neither the Veteran nor his attorney has raised any issues with the duty to notify or duty to assist. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that “the Board's obligation to read filings in a liberal manner does not require the Board . . . to search the record and address procedural arguments when the veteran fails to raise them before the Board”); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). Increased Rating Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Schedule), found in 38 C.F.R. § Part 4 (2018). The Schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of or incident to military service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § § 4.1 (2018). Where there is a question as to which of two evaluations shall be applied, the higher evaluation 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 (2018). When reasonable doubt arises as to the degree of disability, such doubt will be resolved in the Veteran's favor. 38 C.F.R. § § 4.3 (2018). In considering the severity of a disability, it is essential to trace the medical history of the Veteran. 38 C.F.R. § §§ 4.1, 4.2, 4.41 (2018). Consideration of the whole-recorded history is necessary so that a rating may accurately reflect the elements of any disability present. 38 C.F.R. § § 4.2; Peyton v. Derwinski, 1 Vet. App. 282 (1991). Although the regulations do not give past medical reports precedence over current findings, the Board is to consider the Veteran's medical history in determining the applicability of a higher rating for the entire period in which the appeal has been pending. Powell v. West, 13 Vet. App. 31, 34 (1999). Where entitlement to compensation has been established and an increase in the disability rating is at issue, the present level of disability is of primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Where an appeal is based on an initial rating for a disability, however, evidence contemporaneous with the claim and the initial rating decision are most probative of the degree of disability existing when the initial rating was assigned and should be the evidence “used to decide whether an original rating on appeal was erroneous.” Fenderson v. West, 12 Vet. App. 119, 126 (1999). In either case, if later evidence indicates that the degree of disability increased or decreased following the assignment of the initial rating, staged ratings may be assigned for separate periods of time. Fenderson, 12 Vet. App. at 126; Hart v. Mansfield, 21 Vet. App. 505 (2007) (noting that staged ratings are appropriate whenever the factual findings show distinct time periods in which a disability exhibits symptoms that warrant different ratings). When adjudicating an increased rating claim, the relevant time period for consideration is the time period one year before the claim was filed. Hart, 21 Vet. App. at 509. 1. Entitlement to an increased disability rating, in excess of 20 percent prior to February 26, 2019, and in excess of 40 percent on and after February 26, 2019, for service-connected lumbar spine DDD The Veteran's low back disability is evaluated under the General Rating Formula for Diseases and Injuries of the Spine. 38 C.F.R. § 4.71a , Diagnostic Codes (DC) 5235-5243. Prior to February 26, 2019, the current 20 percent evaluation is warranted for forward flexion greater than 30 degrees but not greater than 60 degrees or when the combined range of motion of the thoracolumbar spine is not greater than 120 degrees, or when there is muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. On and after February 26, 2019, a 40 percent evaluation is assigned for forward flexion of 30 degrees or less, or favorable ankylosis of the entire thoracolumbar spine. A 50 percent disability rating is warranted if there is unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent evaluation is warranted if there is unfavorable ankylosis of the entire spine. Associated objective neurologic abnormalities are to be rated separately under an appropriate diagnostic code. For purposes of VA compensation, 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 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 combined range of motion of thoracolumbar spine is to 240 degrees. For VA compensation purposes, unfavorable ankylosis is a disability in which 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 (zero degrees) always represents favorable ankylosis. 38 C.F.R. § § 4.71a , DC 5235-5243, n.5 (2016). Under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, a 40 percent evaluation is warranted when there are incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months. A maximum 60 percent evaluation is warranted when there are incapacitating episodes having a total duration of at least 6 weeks during the past 12 months. For the purposes of evaluations under DC 5243, an incapacitating episode is a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician. Disability of the musculoskeletal system is primarily the inability, due to damage or infection in the parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. It is essential that the examination on which ratings are based adequately portray the anatomical damage and the functional loss with respect to all of these elements. In evaluating disabilities of the musculoskeletal system, it is necessary to consider, along with the schedular criteria, functional loss due to flare-ups of pain, fatigability, incoordination, pain on movement, and weakness. DeLuca v. Brown, 8 Vet. App. 202 (1995). The factors involved in evaluating, and rating disabilities of the joints include weakened movement (due to muscle injury, disease or injury of peripheral nerves, divided or lengthened tendons, etc.); excess fatigability; incoordination (impaired ability to execute skilled movements smoothly); more movement than normal (from flail joint, resections, nonunion of fracture, relaxation of ligaments, etc.); less movement than normal (due to ankylosis, limitation or blocking, adhesions, tendon-tie-up, contracted scars, etc.); or pain on movement, swelling, deformity, or atrophy of disuse. 38 C.F.R. § § 4.45. For disabilities evaluated on the basis of limitation of motion, VA was required to apply the provisions of 38 C.F.R. § §§ 4.40, and 4.45, pertaining to functional impairment. DeLuca v. Brown, 8 Vet. App. 202 (1995). In applying these regulations, VA should obtain examinations in which the examiner determined whether the disability was manifested by weakened movement, excess fatigability, or incoordination. These determinations were, if feasible, be expressed in terms of the degree of additional range-of-motion loss due to any weakened movement, excess fatigability, or incoordination. DeLuca, 8 Vet. App. 202. Although pain may cause functional loss, pain, itself, does not constitute functional loss and is just one factor to be considered when evaluating functional impairment. Mitchell v. Shinseki, 24 Vet. App. 32, 33, 43 (2011). Pain must affect some aspect of the normal working movements of the body such as excursion, strength, speed, coordination and endurance to constitute functional loss. Mitchell, 24 Vet. App. at 33, 43. Pursuant to 38 C.F.R. § §§ 4.40 and 4.45, the possible manifestations of functional loss include decreased or abnormal excursion, strength, speed, coordination, or endurance (38 C.F.R. § §§ 4.40), as well as less or more movement than is normal, weakened movement, excess fatigability, and pain on movement (as well as swelling, deformity, and atrophy) that affects stability, standing, and weight-bearing (38 C.F.R. § § 4.45 ). Thus, functional loss caused by pain must be rated at the same level as if the functional loss were caused by any of the other factors cited above. Therefore, in rating the severity of a joint disability, VA must determine the overall functional impairment due to these factors. Mitchell, 25 Vet. App. 32. “[A] VA examination of the joints must, wherever possible, include the results of the range of motion testing described in the final sentence of” 38 C.F.R. § § 4.59. See Correia v. McDonald, 28 Vet. App. 158 (2016). Specifically, VA examinations must include joint testing for pain on both active and passive motion, in weight-bearing and non-weight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint. In increased evaluation claims, a VA examination report is not adequate without an explanation for an examiner’s failure to evaluate the functional effects of a flare-up. Sharp v. Shulkin, 29 Vet. App. 26 (2017). The Board may accept a VA examiner’s statement that he or she cannot offer an opinion in that regard without resorting to speculation, but only after determining that this is not based on the absence of procurable information or on a particular examiner’s shortcomings or general aversion to offering an opinion on issues not directly observed. The Board finds that compliance with these requirements is not required herein. Unfavorable ankylosis is required for an increased evaluation for the lumbar spine DDD. Thus, even if the examinations do not contain all the information for properly assessing functional loss, including on weight bearing and during flare-ups, a higher rating cannot be awarded without evidence of unfavorable ankylosis absent ankylosis. See Johnston v. Brown, 10 Vet. App. 80 (1997). Diagnostic Code 5243 provides that intervertebral disc syndrome (preoperatively or postoperatively) be rated either under the General Rating Formula for Disease and Injuries of the Spine, or under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, whichever method results in the higher evaluation when all disabilities are combined under 38 C.F.R. § § 4.25. 38 C.F.R. § § 4.71a, Diagnostic Code 5243 (2018). Under Diagnostic Code 5243, a 20 percent evaluation is assigned for incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months. A 40 percent evaluation is assigned for incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months. A maximum 60 percent rating is warranted where there are incapacitating episodes having a total duration of at least six weeks during the past 12 months. Diagnostic Code 5243 defines an incapacitating episode as a period of acute signs and symptoms that requires bed rest prescribed by a physician and treatment by a physician. Before addressing the Veteran’s claim under the General Rating Formula for Diseases and Injuries of the Spine, the Board first finds that an increased evaluation for IVDS under the Formula for Rating IVDS Based on Incapacitating Episodes is not warranted at any point during the appeal. Here, the evidence does not show, and the Veteran does not assert, that there was physician-ordered bed rest.   Next, prior to February 26, 2019, the evidence supports an increased evaluation. VA treatment records dated from 2010 through February 2019 indicate chronic back pain. In a November 2012 VA record, the Veteran reported 4/10 low back pain. The pain was dull but sharp at times and radiates to the right buttocks. Pain is worse in the evening and with activity. Prolonged walking and standing exacerbate the pain. He denied weakness, numbness, or incontinence. In March 2014 VA record, the Veteran was provided with a back brace. An August 2014 VA record noted a lumbar spine nerve block. A December 2011 VA examination was conducted. The Veteran reported constant low back pain with weakness in the legs. The pain radiated over the thighs bilaterally with tingling sensation in both feet, left worse than right. The pain flares up after walking more than 2 blocks, climbing stairs, and bending or stooping. There were occasional flare-ups. He takes pain pills and wears a back brace. There were no bowel disturbances, but there was urinary frequency. The pain did not interfere with his activities of daily living. Upon examination, there was no deformity, muscle spasm, tenderness over the lower lumbar spine. There was flexion to 50 degrees with pain beginning at 30 degrees. Extension was to 20 degrees with pain at 10 degrees. Right and left lateral flexion were to 20 degrees, with pain at 10 degrees. Right and left lateral rotation is to 30 degrees, with pain starting at 20 degrees. Repetitive motion does not produce any additional limitation of motion due to pain, weakness, fatigue, lack of endurance, or incoordination. Straight leg raising is 60 degrees on the left and 70 degrees on the right. A neurological examination showed normal sensation and muscle strength, and ankle jerks, but a decrease in the knee jerks bilaterally. There was a negative Lasegue sign. The diagnoses included bilateral radiculopathy. A September 2014 VA examination was conducted. The Veteran reported pain down the left leg. He reported multiple epidural injections and a nerve block. He reports urinary incontinence. The pain was worst when he bends. The Veteran reported flare-ups when he bends the wrong way, which include severe pain and stiffness in the low back. He stated he could walk with a cane, must be close to a bathroom and could not sit or stand for long periods of time. The Veteran could not do any heavy lifting. There was forward flexion to 45 degrees, with pain at the end range of motion. Extension was to 25 degrees, with pain at 20 degrees. Right lateral flexion is to 20 degrees, with pain at the end range of motion. Left lateral flexion is to 20 degrees, without objective evidence of pain. Right lateral rotation is to 25 degrees, with no objective evidence of pain. Left lateral rotation is to 20 degrees, with no objective evidence of pain. Upon repetition, there was no increased loss of range of motion, but there was additional functional loss or impairment, to include less movement than normal, weakened movement, excess fatigability, pain on movement, instability of station, disturbance of locomotion, interference with sitting, standing, and/or weight-bearing, and lack of endurance. There was localized tenderness or pain to palpation of the left buttock and anterior superior iliac spine, and muscle spasm and guarding resulting in abnormal gait or spinal contour. There was 5/5 right lower extremity muscle strength. There was 4/5 muscle strength in the left lower extremity. There was normal knee and ankle reflexes. The right lower extremity sensation testing was normal. There was decreased left lower extremity sensation. Right lower extremity straight leg raise testing was negative. It was positive on the left. The examiner found there was not right radiculopathy. There was no lumbar spine ankylosis. There was also occasional bladder leakage, 3 to 4 times per day, that is related to lumbar spine DDD. An April 2018 VA record, the Veteran reported pain that radiated down the legs. He denied bladder and bowel incontinence. He reported ED. Resolving all doubt in favor of the Veteran, the Board finds that a 40 percent evaluation, but no higher, is warranted prior to February 26, 2019. As noted, in the 2011 VA examination, there was flexion limited to 30 degrees with pain. As the Veteran has described additional functional loss and flare-ups, the Board finds this more nearly approximates flexion limited to 30 degrees or less. See 38 C.F.R. §§ 4.7,4,40, 4.45, 4.59 (2018); DeLuca, 8 Vet. App. 202. It is noted that the 2014 VA examination also noted flexion in excess of that finding - but functional loss was not fully assessed. Accordingly, and resolving all doubt in favor of the Veteran, the Board finds that these findings meet the criteria for a 40 percent evaluation. At no point, however, do the findings show ankylosis. Range of motion findings were 100 and 150 degrees at the 2011 and 2014 VA examinations, respectively. Accordingly, an evaluation in excess of that is not warranted. Next, on and after February 26, 2019, the Board finds that an increased evaluation for the Veteran’s lumbar spine DDD under the General Rating Formula for Disease and Injuries of the Spine is not warranted. In order to receive a rating in excess of 40 percent, the Veteran would have to demonstrate unfavorable ankylosis of the entire spine. While the Veteran has significant limitation of the lumbar spine, unfavorable ankylosis of the entire spine has not been shown or approximated for the duration of the appeal. At the February 2019 VA examination, when considering pain, there was forward flexion to 25 degrees, extension to 15 degrees, bilateral lateral flexion to 15 degrees, and bilateral lateral rotation to 15 degrees. The examiner noted that there was no ankylosis of the spine. The examiner elicited relevant information from the Veteran regarding his flare-ups of thoracolumbar spine and asked him to describe the additional functional loss, if any, he suffered during flares. The examination report shows that the Veteran would have flare-ups after prolonged walking, standing sitting, bending, lifting more than 20 pounds, and twisting. The Veteran described he experienced functional loss or impairment during any increased physical activity making it difficult for him move around. The examination was not conducted during a flare up; however, the examiner found that the Veteran’s examination is medically consistent with the Veteran’s statements describing functional loss during flare-ups. Here, a rating in excess of 40 percent for lumbar DDD is not warranted as there is range of motion of the lumbar spine of 100 degrees. In order to achieve a higher rating in excess of 40 percent, the Veteran's low back would have to demonstrate unfavorable ankylosis of the entire thoracolumbar spine. 2. Entitlement to ratings in excess of 10 percent for left lower extremity radiculopathy for the period prior to September 27, 2014, and in excess of 20 percent thereafter The Veteran submitted an application for a total disability rating based on individual unemployability in November 2011. The RO construed this request to include a claim for an increased rating for the Veteran’s left lower extremity radiculopathy. The radiculopathy is rated as 10 percent disabling prior to September 27, 2014, and as 20 percent disabling on and after that date. The Veteran’s radiculopathy is evaluated under DC 8526, for paralysis of the femoral nerve. For paralysis of the femoral nerve, disability ratings of 10 percent, 20 percent, and 30 percent are assignable for incomplete paralysis which is mild, moderate, or severe in degree, respectively. A 40 percent rating is assigned for complete paralysis of quadriceps extensor muscles. 38 C.F.R. §§ 4.124a, Diagnostic Code 8626. For paralysis of the sciatic nerve, disability ratings of 10 percent, 20 percent, and 40 percent are assignable for incomplete paralysis which is mild, moderate, or moderately severe in degree, respectively. For severe incomplete paralysis, with marked muscular atrophy, a 60 percent evaluation was assigned. An 80 percent evaluation is assigned for complete paralysis, where the foot dangles and drops, no active movement possible of muscles below the knee, and the flexion of knee weakened or (very rarely) lost. 38 C.F.R. §§ 4.124a, Diagnostic Code 8620. When the involvement is only sensory, the rating should be for the mild, or at most, the moderate degree. In rating peripheral nerve disability, neuritis, characterized by loss of reflexes, muscle atrophy, sensory disturbances, and constant pain, at times excruciating, is to be rated on the scale provided for injury of the nerve involved, with a maximum equal to severe, incomplete paralysis. The maximum rating to be assigned for neuritis not characterized by organic changes referred to in this section will be that for moderate incomplete paralysis, or with sciatic nerve involvement, for moderately severe incomplete paralysis. 38 C.F.R. §§ 4.123. After a thorough review of the record, the Board finds that increased evaluations are not warranted for left lower extremity femoral nerve radiculopathy. A December 2011 VA examination, there was normal sensation and muscle strength. There was decreased knee jerks and normal ankle jerks. In the September 2014 VA examination, the examiner found that the Veteran’s low back disorder caused moderate femoral nerve radiculopathy of the left lower extremity. There was 4/5 muscle strength, normal reflexes, decreased sensation of the thighs and knees, normal sensation of the lower legs, foot, and toes. There was moderate constant pain with mild paresthesias/dysesthesia and numbness. The examiner found the radiculopathy was moderate. In the February 2019 VA examination, the examiner found the Veteran’s low back disorder caused moderate sciatic radiculopathy of the left lower extremity. The examination showed full muscle strength and no muscle atrophy. There were absent reflexes and decreased sensation in the lower leg and ankle and absent reflexes in feet and toes. There was moderate constant pain with severe intermittent pain. There was moderate paresthesias and dysesthias and severe numbness. The examiner noted sciatic nerve neuritis, rather than femoral neve neuritis. The Board finds that increased evaluations are not warranted. Prior to September 27, 2014, the evidence shows normal sensation and muscle strength with decreased reflexes. This more nearly approximates mild, not moderate, neuritis. On and after that date, the evidence shows moderate radiculopathy. Both the 2014 and 2019 VA examiners found the radiculopathy were moderate. Additionally, there was 4/5 or 5/5 muscle strength, although in 2019 some reflexes were missing. There was moderate constant pain, and mild or moderate paresthesias and dysesthesia. These findings more nearly approximate moderate, and not severe or moderately severe, neuritis. Accordingly, increased evaluations are not warranted. REASONS FOR REMAND 1. Entitlement to a separate evaluation for neurological bladder impairment as part of the Veteran’s service-connected lumbar spine DDD. Remand is required regarding this issue in order to obtain clarification. AT the December 2011 VA examination, the Veteran reported urinary frequency. At the September 2014 VA examination, the examiner found there was occasional bladder leakage due to the lumbar spine DDD. The 2019 VA examiner did not appear to elicit any testimony on this issue and no determinations were made. Accordingly, an addendum opinion should be obtained.   2. Prior to February 26, 2019, entitlement to a separate evaluation for right lower extremity radiculopathy as part of the Veteran’s service-connected lumbar spine DDD. Remand is required regarding this issue in order to obtain clarification. The 2019 VA examiner found there was right lower extremity radiculopathy, effective February 26, 2019. This was the date of the examination. However, a December 2011 VA examiner noted bilateral radiculopathy. Accordingly, an addendum opinion should be obtained regarding whether there was right lower extremity radiculopathy prior to February 26, 2019. Second, The matters are REMANDED for the following action: Obtain an addendum opinion regarding bladder impairment and right lower extremity radiculopathy. The entire claims file must be made available to and be reviewed by the examiner. If an examination is deemed necessary, it shall be provided. An explanation for all opinions expressed must be provided. The examiner must provide an opinion regarding whether right lower extremity due to lumbar spine DDD was present prior to February 26, 2019. The examiner must provide an opinion regarding whether there is bladder impairment due to the service-connected right lower extremity. The examiner must address the following: 1) the December 2011 VA examination wherein the Veteran reported urinary frequency and the examiner diagnosed bilateral radiculopathy; 2) the September 2014 VA examination where the Veteran reported urinary incontinence; and the examiner found no right radiculopathy; and 3) other medical records if necessary to establish an onset for right radiculopathy. 2. If an examination is deemed necessary, notify the Veteran that it is his responsibility to report for any scheduled examination and to cooperate in the development of the claims, and that the consequences for failure to report for a VA examination without good cause may include denial of the claims. 38 C.F.R. §§ 3.158, 3.655 (2017). In the event that the Veteran does not report for any scheduled examination, documentation must be obtained which shows that notice scheduling the examination was sent to the last known address. It must also be indicated whether any notice that was sent was returned as undeliverable. Kerri Millikan Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Braxton, 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.