Citation Nr: 20003301 Decision Date: 01/14/20 Archive Date: 01/14/20 DOCKET NO. 18-26 731 DATE: January 14, 2020 ORDER Entitlement to an initial evaluation in excess of 30 percent for posttraumatic stress disorder (PTSD) prior to October 5, 2017, and in excess of 70 percent thereafter, is denied. Entitlement to an effective date earlier than October 30, 2015, for the grant of service connection for PTSD is denied. Entitlement to an effective date earlier than June 7, 2013, for the grant of service connection for left lower extremity radiculopathy is denied. Entitlement to an effective date earlier than June 7, 2013, for the assignment of an increased rating of 20 percent for degenerative disc disease of the lumbar spine is denied. REMANDED Entitlement to an increased rating for degenerative disc disease of the lumbar spine (previously evaluated as lumbar strain), currently 20 percent disabling, is remanded. Entitlement to an initial evaluation in excess of 20 percent for left lower extremity radiculopathy is remanded. Entitlement to service connection for chronic sinusitis, to include as due to an undiagnosed illness, is remanded. Entitlement to service connection for chronic headaches is remanded. Entitlement to service connection for chronic fatigue syndrome, to include as due to an undiagnosed illness, is remanded. Entitlement to service connection for right upper extremity paresthesia, to include as due to an undiagnosed illness, is remanded. Entitlement to service connection for left upper extremity paresthesia, to include as due to an undiagnosed illness, is remanded. Entitlement to service connection for a right knee disorder is remanded. Entitlement to service connection for a left knee disorder is remanded. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is remanded. FINDINGS OF FACT 1. For the period prior to October 5, 2017, the Veteran’s PTSD was productive of occupational and social impairment with an occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, but not productive of occupational and social impairment with reduced reliability and productivity. 2. Since October 5, 2017, the Veteran’s PTSD has been productive of occupational and social impairment in most areas, but not total occupational and social impairment. 3. The Veteran filed a claim for service connection for PTSD on October 30, 2015. No earlier record constituted a claim for service connection for PTSD. 4. The Veteran filed a claim for an increased rating for service-connected degenerative disc disease of the lumbar spine on June 7, 2013. The Agency of Original Jurisdiction (AOJ) determined that the Veteran’s radiculopathy of the left lower extremity was a neurological abnormality related to his lumbar spine disability. No earlier record constituted a formal or informal claim for service connection for left lower extremity radiculopathy. 5. The Veteran filed a claim for an increased evaluation for service-connected degenerative disc disease of the lumbar spine on June 7, 2013. The AOJ assigned a 20 percent evaluation for degenerative disc disease of the lumbar spine, effective from June 7, 2013. It was not factually ascertainable that an increase in the Veteran’s lumbar spine disability had occurred prior to June 7, 2013. CONCLUSIONS OF LAW 1. The criteria for an evaluation in excess of 30 percent for PTSD prior to October 5, 2017, have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1-4.7, 4.10, 4.21, 4.126, 4.130, Diagnostic Code 9411. 2. The criteria for an evaluation in excess of 70 percent for PTSD on or after October 5, 2017, have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1-4.7, 4.10, 4.21, 4.126, 4.130, Diagnostic Code 9411. 3. The criteria for an effective date prior to October 30, 2015, for the grant of service connection for PTSD have not been met. 38 U.S.C. § 5110; 38 C.F.R. §§ 3.105, 3.151, 3.155, 3.156, 3.400, 20.200, 20.302, 20.1103. 4. The criteria for an effective date prior to June 7, 2013, for the grant of service connection for left lower extremity radiculopathy have not been met. 38 U.S.C. § 5110; 38 C.F.R. §§ 3.105, 3.151, 3.155, 3.156, 3.400, 20.200, 20.302, 20.1103. 5. The criteria for an effective date earlier than June 7, 2013, for the assignment of a 20 percent evaluation for degenerative disc disease of the lumbar spine have not been met. 38 U.S.C. §§ 5110, 7111; 38 C.F.R. §§ 3.102, 3.400, 20.1400-20.1411. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 1960 to June 1964 and from November 1990 to May 1991. These matters come before the Board of Veterans’ Appeals (Board) on appeal from September 2014, April 2015, and August 2016 rating decisions. In July 2017, the Veteran testified before a Decision Review Officer (DRO) at the Agency of Original Jurisdiction. A transcript of that hearing has been associated with the record. In an April 2018 rating decision, the AOJ increased the evaluation for PTSD to 70 percent, effective from October 5, 2017. Because that evaluation is less than the maximum award allowed under VA law and regulations, the claim for an increased evaluation remained on appeal. AB v. Brown, 6 Vet. App. 35, 38 (1993). Law and Analysis Neither the Veteran nor his representative has raised any issues with the duty to notify or duty to assist with regard to the issues decided herein. 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, found in 38 C.F.R., Part 4. The rating 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. 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. 38 C.F.R. § 4.7. 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. Consideration of the whole-recorded history is necessary so that a rating may accurately reflect the elements of disability present. 38 C.F.R. § 4.2; Peyton v. Derwinski, 1 Vet. App. 282 (1991). While the regulations require review of the recorded history of a disability by the adjudicator to ensure a more accurate evaluation, the regulations do not give past medical reports precedence over the current medical findings. Where the question for consideration is the propriety of the initial rating assigned, evaluation of the evidence since the effective date of the grant of service connection is required. Fenderson v. West, 12 Vet. App. 119, 125-26 (1999). Where VA’s adjudication of the claim for increase is lengthy and factual findings show distinct time periods where the service-connected disability exhibits symptoms which would warrant different ratings, different or “staged” ratings may be assigned for such different periods of time. Fenderson, 12 Vet. App. at 126-27. Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits. VA shall consider all information and lay and medical evidence of record in a case and when there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on its merits, the weight of the evidence must be against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996). The Veteran’s PTSD is currently assigned a 30 percent evaluation prior to October 5, 2017, and a 70 percent evaluation thereafter, pursuant to 38 C.F.R. § 4.130, Diagnostic Code 9411. Under Diagnostic Code 9411, a 30 percent evaluation is warranted when the psychiatric disorder results in occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood; anxiety; suspiciousness; panic attacks (weekly or less often); chronic sleep impairment; mild memory loss (such as forgetting names, directions, recent events). A 50 percent evaluation is warranted when the psychiatric disorder results in reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. A 70 percent evaluation is warranted when the psychiatric disorder results in occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work-like setting); inability to establish and maintain effective relationships. A 100 percent evaluation is warranted when the psychiatric disorder results in total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. The use of the term “such as” in the general rating formula for mental disorders in 38 C.F.R. § 4.130 demonstrates that the symptoms after that phrase are not intended to constitute an exhaustive list, but rather are to serve as examples of the type and degree of symptoms, or their effects, that would justify a particular rating. See Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). It is not required to find the presence of all, most, or even some, of the enumerated symptoms recited for particular ratings. Id. The use of the phrase “such symptoms as,” followed by a list of examples, provides guidance as to the severity of symptoms contemplated for each rating, in addition to permitting consideration of other symptoms, particular to each veteran and disorder, and the effect of those symptoms on the claimant’s social and work situation. Id. In Vazquez-Claudio v. Shinseki, 713 F.3d 112 (Fed. Cir. 2013), the Federal Circuit stated that “a veteran may only qualify for a given disability rating under § 4.130 by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration.” It was further noted that “§ 4.130 requires not only the presence of certain symptoms but also that those symptoms have caused occupational and social impairment in most of the referenced areas.” As noted above, the Veteran’s PTSD is currently assigned an evaluation of 30 percent prior to October 5, 2017. In considering the evidence of record under the laws and regulations as set forth above, the Board concludes that the Veteran does not meet the criteria for a higher evaluation for his PTSD for this time period. A 50 percent rating is warranted when the psychiatric disorder results in occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. In this case, the record does not demonstrate that the Veteran’s overall disability picture is consistent with a 50 percent rating or higher for the period before October 5, 2017. With regard to social impairment, the record shows that the Veteran maintained relationships with family and friends throughout the appeal period. During a July 2016 VA examination, the Veteran indicated that he had been married for 30 years and that he had four adult children. He related that he had a couple of friends and that he attended church. Regarding occupational impairment, the evidence shows that the Veteran had been employed for this entire period. During the July 2016 VA examination, he indicated that he worked at an automotive parts store for the past eight years. As to overall impairment, the July 2016 VA examiner opined that the Veteran had occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by medication. Such an opinion is commensurate with a 10 percent evaluation, whereas the Veteran has already been granted a 30 percent evaluation for the period prior to October 5, 2017. Furthermore, the Veteran’s symptomatology has not been similar to that of the criteria for an evaluation of 50 percent prior to October 5, 2017. The record does not reflect that he exhibited flattened affect, circumstantial, circumlocutory, or stereotyped speech, panic attacks more than once a week, difficulty understanding complex commands, impaired judgement, or impaired abstract thinking prior to October 5, 2017. During the July 2016 VA examination, the Veteran endorsed symptoms of depressed mood, anxiety, suspiciousness, and chronic sleep impairment. He indicated that he avoided crowds of people and flying, that he had intrusive thoughts once every couple of months, and that he had nightmares two to three times per month. After considering the evidence of record, the Board finds that the Veteran’s symptoms approximate the criteria for an evaluation of 30 percent for the period prior to October 5, 2017. Overall, the Veteran has not demonstrated a level of impairment consistent with the 50 percent criteria, nor have the Veteran’s symptoms caused occupational and social functioning with reduced reliability or productivity; with deficiencies in most of the areas; or resulting in total occupational and social impairment as referenced by the 70 and 100 percent evaluation criteria. Mauerhan, supra, Vazquez-Claudio, supra. The criteria for the next higher rating of 50 percent have not been met or approximated for the period prior to October 5, 2017. See 38 C.F.R. § 4.130, Diagnostic Code 9411. The Veteran’s PTSD is currently assigned an evaluation of 70 percent effective from October 5, 2017. In considering the evidence of record under the laws and regulations as set forth above, the Board concludes that the Veteran does not meet the criteria for a 100 percent evaluation for this time period. A 100 percent rating is warranted when the psychiatric disorder results in total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. The evidence of record does not show that the Veteran has total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. The Board emphasizes that the criteria for an evaluation of 100 percent requires both total social and occupational impairment. See Melson v. Derwinski, 1 Vet. App. 334 (1991) (use of the conjunctive “and” in a statutory provision meant that all of the conditions listed in the provision must be met); cf. Johnson v. Brown, 7 Vet. App. 95 (1994) (only one disjunctive “or” requirement must be met in order for an increased rating to be assigned). With regard to social impairment, the record shows that the Veteran has consistently maintained relationships with his family. During an October 2017 VA examination, the Veteran reported that he and his wife of over 30 years were getting along okay. As such, it cannot be said that he has total social impairment With respect to occupational impairment, the Veteran reported that he was fired from his job at the automotive parts store approximately one month ago earlier he had a verbal outburst directed towards a customer. He also indicated that he brought a weapon on the property. The Veteran’s representative has since noted that he is currently working pat-time as a truck driver. See May 2019 correspondence. The October 2017 VA examiner opined that the Veteran had occupational and social impairment with reduced reliability and productivity. Such an opinion is commensurate with a 50 percent evaluation, whereas the Veteran has already been granted a 70 percent evaluation. After considering the evidence of record, the Board finds that the Veteran’s PTSD more closely approximates the criteria for the 70 percent disability rating for the period beginning October 5, 2017. Overall, the Veteran has not demonstrated a level of impairment consistent with the criteria for a total evaluation. Mauerhan, supra, Vazquez-Claudio, supra. The criteria for a total evaluation have not been met or approximated at any time during the appeal period. See 38 C.F.R. § 4.130, Diagnostic Code 9411. Thus, the Board concludes that the weight of the evidence is against a rating in excess of 70 percent for PTSD on or after October 5, 2017. As such, the benefit-of-the-doubt rule does not apply. Gilbert, 1 Vet. App. at 53. Earlier Effective Date Unless specifically provided otherwise, the effective date of an award based on an original claim, a claim reopened after final adjudication, or a claim for increase, of compensation, dependency and indemnity compensation, or pension, shall be fixed in accordance with the facts found, but shall not be earlier than the date of receipt of application therefor. 38 U.S.C. § 5110(a). Effective March 24, 2015, VA amended its regulations to require that all claims governed by VA’s adjudication regulations be filed on a standard form. The amendments implement the concept of an intent to file a claim for benefits, which operates similarly to the informal claim process, but requires that the submission establishing a claimant’s effective date of benefits must be received in one of three specified formats. The amendments also eliminate the constructive receipt of VA reports of hospitalization or examination and other medical records as informal claims to reopen under 38 C.F.R. § 3.157. See 79 Fed. Reg. 57,660 (Sept. 25, 2014) (now codified at 38 C.F.R. §§ 3.1 (p), 3.151, 3.155). The amendments apply only to claims filed on or after March 24, 2015. In this case, because the Veteran’s claim for service connection for left lower extremity radiculopathy was received by VA prior to that date, the former regulations apply, as provided below. However, the Veteran’s claim for service connection for PTSD was not received until October 30, 2015. Under the old regulations, a specific claim in the form prescribed by VA must be filed in order for benefits to be paid or furnished to any individual under the laws administered by VA. 38 U.S.C. § 5101(a); 38 C.F.R. § 3.151(a). The term “claim” or “application” means a formal or informal communication in writing requesting a determination of entitlement or evidencing a belief in entitlement to a benefit. 38 C.F.R. § 3.1(p). Any communication or action indicating an intent to apply for one or more benefits under laws administered by VA from a claimant may be considered an informal claim. Such informal claim must identify the benefit sought. Upon receipt of an informal claim, if a formal claim has not been filed, an application form will be forwarded to the claimant for execution. 38 C.F.R. § 3.155(a). To determine when a claim was received, the Board must review all communications in the claims file that may be construed as an application or claim. See Quarles v. Derwinski, 3 Vet. App. 129, 134 (1992). The effective date of an award of increased compensation shall be the earliest date as of which it is factually ascertainable that an increase in disability had occurred if the claim is received within one year from such date. Otherwise, the effective date will be the date of receipt of the claim. 38 U.S.C. § 5110(b); 38 C.F.R. § 3.400 (o)(2); see also Gaston v. Shinseki, 605 F.3d 979, 983 (Fed. Cir. 2010) (“It is clear from the plain language of [section] 5110(b)(2) that it only permits an earlier effective date for increased disability compensation if that disability increased during the one-year period before the filing of the claim.”); Hazan v. Gober, 10 Vet. App. 511, 519 (1997) (“increase” for this purpose is one to the next disability level); VAOPGCPREC 12-98 (Sept. 23, 1998). PTSD In considering the evidence of record under the laws and regulations as set forth above, the Board concludes that the Veteran is not entitled to an effective date earlier than October 30, 2015, for the grant of service connection for PTSD. The Veteran first filed a claim for service connection for PTSD on October 30, 2015. No earlier record constituted a claim for these benefits. In an August 2016 rating decision, the AOJ granted service connection for PTSD, effective from the date of the October 30, 2015, claim. The record does not contain any earlier communication indicating an intent to file a service connection claim for PTSD. VA is obligated to consider all possible bases for compensation; however, this does not mean that it is required to anticipate any potential claim for a particular benefit where no intention to raise it was expressed. See Brannon v. West, 12 Vet. App. 32, 35 (1998) (holding that before VA can adjudicate a claim for benefits, “the claimant must submit a written document identifying the benefit and expressing some intent to seek it”); see also Talbert v. Brown, 7 Vet. App. 352, 356-57 (1995). Based on the foregoing, the Board concludes that, a claim for service connection for PTSD was not received prior to the claim submitted on October 30, 2015, which is the effective date currently assigned. As the weight of the evidence is against the Veteran’s claim, the benefit-of-the-doubt rule does not apply, and the claim is denied. Gilbert, 1 Vet. App. 49, 53. Left Lower Extremity Radiculopathy In considering the evidence of record under the laws and regulations as set forth above, the Board concludes that the Veteran is not entitled to an effective date earlier than June 7, 2013, for the grant of service connection for left lower extremity radiculopathy. The Veteran filed a claim for an increased rating for his service-connected degenerative disc disease of the lumbar spine on June 7, 2013. No earlier record constituted a formal or informal claim for service connection for left lower extremity radiculopathy. In a September 2014 rating decision, the AOJ granted service connection for left lower extremity radiculopathy related to his service-connected degenerative disc disease of the lumbar spine, effective from the date of the June 7, 2013, which was the date of the claim for an increased rating for his service-connected lumbar spine disability. Regarding the date of claim, the record does not contain any earlier communication indicating an intent to file a service connection claim for left lower extremity radiculopathy. VA is obligated to consider all possible bases for compensation; however, this does not mean that it is required to anticipate any potential claim for a particular benefit where no intention to raise it was expressed. See Brannon v. West, 12 Vet. App. 32, 35 (1998) (holding that before VA can adjudicate a claim for benefits, “the claimant must submit a written document identifying the benefit and expressing some intent to seek it”); see also Talbert v. Brown, 7 Vet. App. 352, 356-57 (1995). Based on the foregoing, the Board concludes that, a formal or informal claim for service connection for left lower extremity radiculopathy was not received prior to the claim for an increased rating for the Veteran’s service-connected lumbar spine disability submitted on June 7, 2013, which is the effective date currently assigned. As the weight of the evidence is against the Veteran’s claim, the benefit-of-the-doubt rule does not apply, and the claim is denied. Gilbert, 1 Vet. App. 49, 53. Degenerative Disc Disease of the Lumbar Spine In considering the evidence of record under the laws and regulations as set forth above, the Board concludes that the Veteran is not entitled to an effective date earlier than June 7, 2013, for the grant of a 20 percent evaluation for degenerative disc disease of the lumbar spine. The Veteran filed a claim for an increased rating for his service-connected degenerative disc disease of the lumbar spine on June 7, 2013. No earlier record constituted a formal or informal claim for an increased rating for his lumbar spine disability. In a September 2014 rating decision, the AOJ increased the evaluation for degenerative disc disease of the lumbar spine to 20 percent, effective from the date of the June 7, 2013, which was the date of the claim for an increased rating for his lumbar spine disability. The record does not contain any earlier communication indicating an intent to file an increased rating claim for the lumbar spine disability. VA is obligated to consider all possible bases for compensation; however, this does not mean that it is required to anticipate any potential claim for a particular benefit where no intention to raise it was expressed. See Brannon v. West, 12 Vet. App. 32, 35 (1998) (holding that before VA can adjudicate a claim for benefits, “the claimant must submit a written document identifying the benefit and expressing some intent to seek it”); see also Talbert v. Brown, 7 Vet. App. 352, 356-57 (1995). Generally, as outlined above, the laws and regulations regarding effective dates permit an effective date for the award of increased compensation up to one year before the filing of the claim if it is factually ascertainable that disability increased to the next disability level during the one-year period. In this case, there is no evidence showing that the Veteran’s lumbar spine disability had increased in severity until the May 2014 VA examination that was afforded to the Veteran following his June 7, 2013, claim for an increased rating. In fact, the claims file does not contain any medical evidence or lay statements showing that a 20 percent evaluation was warranted for his service-connected lumbar spine disability between June 7, 2012, and June 7, 2013. In fact, a November 2012 private medical record was received in June 2014 and indicated that the Veteran did not have muscle spasms and that he had forward flexion to his thighs. See 38 C.F.R. § 4.71a, Diagnostic Codes 5236-5243. Thus, it was not factually ascertainable that the disability had increased in severity during the year prior to his claim. Based on the foregoing, the Board concludes that, a formal or informal claim for an increased rating for degenerative disc disease of the lumbar spine was not received prior to the claim submitted on June 7, 2013, which is the effective date currently assigned. The evidence also does not show that it was factually ascertainable that an increase in disability had occurred one year prior to the claim. As the weight of the evidence is against the Veteran’s claim, the benefit-of-the-doubt rule does not apply, and the claim is denied. Gilbert, 1 Vet. App. 49, 53. REASONS FOR REMAND The Veteran was most recently afforded a VA back examination in October 2017 in connection with his claims for increased ratings for his lumbar spine disability and left lower extremity radiculopathy. However, in light of a decision issued by the United States Court of Appeals for Veterans Claims (Court), a remand is required. Specifically, the Court held that 38 C.F.R. § 4.59 requires VA examinations to include joint testing for pain on both active and passive range of motion, as well as with weight-bearing and nonweight-bearing. Correia v. McDonald, 25 Vet. App. 158 (2016). In this case, the VA examination report did not include these findings. Thus, a remand is necessary to ensure that the VA examination complies with the requirements of the holding in Correia. As resolution of the claim for an increased rating for the Veteran’s lumbar spine disability may have an impact on the Veteran’s claim for increased evaluation for left lower extremity radiculopathy, the issues are inextricably intertwined. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). With respect to the Veteran’s claims for service connection for right and left knee disorders, the Board notes that the Veteran’s representative has challenged the adequacy of an October 2017 knees examination. See April 2019 statement. Specifically, he asserted that the VA examiner did not address the Veteran’s contentions that he injured his knees when he carried and set up 45-to 55-pound M2 burners in dining facilities during deployment. Therefore, the Veteran should be afforded another VA examination. Similarly, in his April 2019 statement, the Veteran’s representative challenged the adequacy of an October 2014 VA sinusitis examination. Specifically, he noted that the VA examiner only discussed the Veteran’s sinusitis in relation to his first period of service in the 1960s, but he did not address the Veteran’s second period of service during the Gulf War. Therefore, an additional VA medical opinion is needed. In addition, the Veteran’s representative contended that the Veteran’s headaches were caused by his sinusitis. As resolution of the claim for service connection for sinusitis may have an impact on the Veteran’s claim for service connection for chronic headaches, the issues are inextricably intertwined. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). Moreover, in an April 2018 statement, the Veteran’s representative noted that the Veteran described a three-week hospitalization during which he was treated for symptoms of chronic fatigue shortly upon returning home from the Gulf War. The Veteran’s representative contended that the AOJ should schedule the Veteran for a VA examination to address the Veteran’s claim. Therefore, on remand, the Veteran should be afforded a VA examination to address the nature and etiology of any fatigue. Additionally, in the April 2018 and April 2019 statements, the Veteran’s representative has asserted that the Veteran’s claims for service connection for paresthesia of the right and left upper extremities are part and parcel of cervical spine degeneration. The Board notes that the Veteran has not filed a claim for service connection for a cervical spine disorder. However, the Board finds that the Veteran should be afforded a VA examination to address the nature and etiology of any paresthesia of the bilateral upper extremities. Finally, in Rice v. Shinseki, 22 Vet. App. 447 (2009), the Court held that a claim for TDIU is part and parcel of an increased rating claim when such claim is raised by the record. In this case, the Veteran and his representative have raised the issue by asserting that the Veteran was unemployable, in part, due to his service-connected PTSD. Under these circumstances, the AOJ should develop a claim for TDIU in accordance with Rice. Id. The matters are REMANDED for the following action: 1. The agency of original jurisdiction (AOJ) should request that the Veteran provide the names and addresses of any and all health care providers who have provided treatment for his low back, left lower extremity radiculopathy, headaches, knees, sinusitis, fatigue, and paresthesia of the bilateral upper extremities. After acquiring this information and obtaining any necessary authorization, the AOJ should obtain and associate these records with the claims file. The AOJ should also obtain any outstanding VA medical records. 2. After completing the foregoing development, the Veteran should be afforded a VA examination to ascertain the severity and manifestations of his service-connected lumbar spine disability. Any and all studies, tests, and evaluations deemed necessary by the examiner should be performed. The examiner is requested to review all pertinent records associated with the claims file. The examiner should note that the Veteran is competent to attest to factual matters of which he has first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. The examiner should report all signs and symptoms necessary for rating the lumbar spine disability under the rating criteria. In particular, the examiner should provide the range of motion in degrees of the lumbar spine. In so doing, the examiner should test the Veteran’s range of motion in active motion, passive motion, weight-bearing, and nonweight-bearing. If the examiner is unable to conduct the required testing or concludes that the required testing is not necessary in this case, he or she should clearly explain so in the report. The examiner should also comment on whether there is any form of ankylosis. In addition, the examiner should state the total duration of incapacitating episodes over the past 12 months and identify all neurological manifestations of the disability. The presence of objective evidence of pain, excess fatigability, incoordination and weakness should also be noted, as should any additional disability (including additional limitation of motion) due to these factors. Further, the VA examiner should comment as to whether range of motion measurements for active motion, passive motion, weight-bearing, and/or nonweight-bearing can be estimated for the other VA examinations conducted during the appeal period. If the examiner is unable to provide a retrospective opinion as to these specific range of motion findings, he or she should clearly explain so in the report. In addition, the examiner should discuss any impact that the service-connected lumbar spine disability has on the Veteran’s activities of daily living and ability to work. A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. Because it is important “that each disability be viewed in relation to its history[,]” 38 C.F.R. § 4.1, copies of all pertinent records in the appellant’s claims file, or in the alternative, the claims file, must be made available to the examiner for review. 3. After completing the foregoing development, the Veteran should be afforded a VA examination to ascertain the current severity and manifestations of his service-connected left lower extremity radiculopathy. Any and all studies, tests, and evaluations deemed necessary by the examiner should be performed. The examiner is requested to review all pertinent records associated with the claims file. It should be noted that the Veteran is competent to attest to factual matters of which he has first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. The examiner should report all signs and symptoms necessary for rating the disabilities. In particular, the examiner should identify the affected nerve or nerve group. For each nerve or nerve group affected, the examiner should indicate whether the impairment is mild, moderate, or severe. He or she should also state whether there is incomplete or complete paralysis. To the extent possible, the examiner should distinguish the symptomatology attributable to each nerve. If the examiner is unable to distinguish the symptoms attributed to each nerve, the examiner should so state in the report. A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. Because it is important “that each disability be viewed in relation to its history [,]” 38 C.F.R. § 4.1, copies of all pertinent records in the Veteran’s claims file, or in the alternative, the claim file, must be made available to the examiner for review. 4. After any additional records are associated with the claims file, the Veteran should be afforded a VA examination to determine the nature and etiology of any bilateral knee disorders that may be present. Any and all studies, tests, and evaluations deemed necessary by the examiner should be performed. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran’s service treatment records, post-service medical records, and assertions. The examiner should note that the Veteran is competent to attest to factual matters of which he has first-hand knowledge. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should state this with a fully reasoned explanation. The examiner should identify all current bilateral knee disorders. For each diagnosis identified, the examiner should provide an opinion as to whether it is at least as likely as not that the disorder manifested in or is otherwise causally or etiologically related to the Veteran’s military service, to include his duties therein. The Veteran’s representative has asserted that he injured his knees when he carried and set up 45-to 55-pound M2 burners in dining facilities during deployment. See April 2019 statement. (The term “at least as likely as not” does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of conclusion as it is to find against it.) A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. Because it is important “that each disability be viewed in relation to its history [,]” 38 C.F.R. § 4.1, copies of all pertinent records in the Veteran’s claims file, or in the alternative, the claim file, must be made available to the examiner for review. 5. After completing the foregoing development, the Veteran should be afforded a VA examination to determine the nature and etiology of any sinusitis that may be present. Any and all studies, tests, and evaluations deemed necessary by the examiner should be performed. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran’s service treatment records, post-service medical records, and assertions. The examiner should note that the Veteran is competent to attest to factual matters of which he has first-hand knowledge. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should state this with a fully reasoned explanation. The examiner should provide an opinion as to whether it is at least as likely as not that the Veteran has sinusitis that manifested during active service or is otherwise causally or etiologically related to his active service, to include any environmental exposure or symptomatology therein. (The term “at least as likely as not” does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of conclusion as it is to find against it.) A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. Because it is important “that each disability be viewed in relation to its history [,]” 38 C.F.R. § 4.1, copies of all pertinent records in the Veteran’s claims file, or in the alternative, the claim file, must be made available to the examiner for review. 6. After completing the foregoing development, the Veteran should be afforded a VA examination to determine the nature and etiology of any headaches that may be present. Any and all studies, tests, and evaluations deemed necessary by the examiner should be performed. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran’s service treatment records, post-service medical records, and assertions. The examiner should note that the Veteran is competent to attest to factual matters of which he has first-hand knowledge. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should state this with a fully reasoned explanation. The examiner should provide an opinion as to whether it is at least as likely as not that the Veteran has chronic headaches that manifested during active service or are otherwise causally or etiologically related to his active service, to include any environmental exposure or symptomatology therein. The examiner should also address the Veteran’s contention that his chronic headaches are caused or aggravated by his sinusitis. (The term “at least as likely as not” does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of conclusion as it is to find against it.) A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. Because it is important “that each disability be viewed in relation to its history [,]” 38 C.F.R. § 4.1, copies of all pertinent records in the Veteran’s claims file, or in the alternative, the claim file, must be made available to the examiner for review. 7. After the above development has been completed, the Veteran should be afforded a VA examination to determine the nature and etiology of any fatigue that may be present. Any and all studies, tests, and evaluations deemed necessary by the examiner should be performed. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran’s service treatment records, post-service medical records, and assertions. The Veteran has claimed that he has chronic fatigue that resulted from his exposure to environmental hazards while he served in Southwest Asia during the Gulf War. The examiner should note that the Veteran is competent to attest to matters of which he has first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the appellant, the examiner should provide a fully reasoned explanation. The examiner should opine as to the following: (a) The examiner should identify all current disorders involving fatigue. In so doing, he or she should state whether the Veteran has chronic fatigue syndrome and address whether the Veteran’s fatigue is a disorder that is separate and apart from his service-connected disabilities, to include his posttraumatic stress disorder (PTSD). (b) For any diagnosis identified, the examiner should render an opinion as to whether it is at least as likely as not that the disorder is causally or etiology related to the Veteran’s military service, including any symptomatology therein. The examiner should also address whether any current disorder is related to his exposure to environmental hazards while he served in Southwest Asia during the Gulf War. In addition, the examiner should opine as to whether the current disorder is caused by or aggravated by his service-connected disabilities, to include his posttraumatic stress disorder (PTSD). (c) If the Veteran has any symptomatology that is not attributable to a known clinical diagnosis the examiner should indicate whether the Veteran has objective indications of a chronic disability resulting from an undiagnosed illness or medically unexplained chronic multisystem illness, as established by history, physical examination, and laboratory tests. (The term “at least as likely as not” does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of a certain conclusion as it is to find against it.) A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. Because it is important “that each disability be viewed in relation to its history [,]” 38 C.F.R. § 4.1, copies of all pertinent records in the appellant’s claims file, or in the alternative, the claims file, must be made available to the examiner for review. 8. After the above development has been completed, the Veteran should be afforded a VA examination to determine the nature and etiology of any paresthesia of the bilateral upper extremities that may be present. Any and all studies, tests, and evaluations deemed necessary by the examiner should be performed. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran’s service treatment records, post-service medical records, and assertions. The Veteran has claimed that he has bilateral upper extremity paresthesia that resulted from his exposure to environmental hazards while he served in Southwest Asia during the Gulf War. The Veteran’s representative has alternatively contended that the Veteran’s bilateral upper paresthesia was caused by cervical spine degeneration. The examiner should note that the Veteran is competent to attest to matters of which he has first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the appellant, the examiner should provide a fully reasoned explanation. The examiner should opine as to the following: (a) The examiner should identify all current disorders involving paresthesia of the bilateral upper extremities. (b) For any diagnosis identified, the examiner should render an opinion as to whether it is at least as likely as not that the disorder is causally or etiology related to the Veteran’s military service, including any symptomatology therein. The examiner should also address whether any current disorder is related to his exposure to environmental hazards while he served in Southwest Asia during the Gulf War. (c) If the Veteran has any symptomatology that is not attributable to a known clinical diagnosis the examiner should indicate whether the Veteran has objective indications of a chronic disability resulting from an undiagnosed illness or medically unexplained chronic multisystem illness, as established by history, physical examination, and laboratory tests. (The term “at least as likely as not” does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of a certain conclusion as it is to find against it.) A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. Because it is important “that each disability be viewed in relation to its history [,]” 38 C.F.R. § 4.1, copies of all pertinent records in the appellant’s claims file, or in the alternative, the claims file, must be made available to the examiner for review. 9. The AOJ should consider whether the Veteran is entitled to TDIU under the provisions of 38 C.F.R. § 4.16, based on impairment attributable to his service-connected disabilities, in accordance with Rice v. Shinseki, 22 Vet. App. 447 (2009). In so doing, the AOJ may decide to pursue further development of the Veteran’s employment history or to obtain additional medical evidence or medical opinion, as is deemed necessary. 10. The AOJ should conduct any other development as may be indicated. J.W. ZISSIMOS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Osegueda, 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.