Citation Nr: 20006958 Decision Date: 01/28/20 Archive Date: 01/28/20 DOCKET NO. 14-24 491A DATE: January 28, 2020 ORDER Entitlement to a rating in excess of 40 percent for degenerative disc disease; degenerative joint disease, thoracic spine, is denied. Entitlement to a separate initial rating for radiculopathy of the right lower extremity, rated as 10 percent disabling, but not higher, prior to April 27, 2016, is granted. Entitlement to a separate rating for radiculopathy of the right lower extremity, rated as noncompensably disabling, but not higher, beginning April 27, 2016, is granted. Entitlement to a separate initial rating for radiculopathy of the left lower extremity, rated as 10 percent disabling, but not higher, prior to April 11, 2014, is granted. Entitlement to a separate rating for radiculopathy of the left lower extremity, rated as noncompensably disabling, but not higher, beginning April 11, 2014, is granted. FINDINGS OF FACT 1. Veteran’s degenerative disc disease; degenerative joint disease, thoracic spine, is manifest by 30 degrees forward flexion and 5 degrees extension, at worst, without ankylosis. 2. The Veteran’s degenerative disc disease; degenerative joint disease, thoracic spine, does not manifest episodes of incapacitation with periods of acute signs and symptoms requiring bed rest prescribed by a physician. 3. The Veteran’s radiculopathy of the right lower extremity most nearly approximates mild incomplete paralysis for the period prior to April 27, 2016. 4. The Veteran did not have radiculopathy of the right lower extremity for the period beginning April 27, 2016. 5. The Veteran’s radiculopathy of the left lower extremity most nearly approximates mild incomplete paralysis for the period prior to April 11, 2014. 6. The Veteran did not have radiculopathy of the right lower extremity for the period beginning April 11, 2014. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 40 percent for degenerative disc disease; degenerative joint disease, thoracic spine, have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.10, 4.14, 4.45, 4.71a, Diagnostic Codes 5003, 5010, 5235–5243. 2. The criteria for a separate initial rating of 10 percent, but not higher, for radiculopathy of the right lower extremity for the period prior to April 27, 2016, have been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.14, 4.123, 4.124, 4.124a, Diagnostic Code 8526. 3. The criteria for a separate rating for radiculopathy of the right lower extremity, rated as noncompensably disabling, but not higher, beginning April 27, 2016, have been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.14, 4.31, 4.123, 4.124, 4.124a, Diagnostic Code 8526. 4. The criteria for a separate initial rating of 10 percent, but not higher, for radiculopathy of the left lower extremity for the period prior to April 11, 2014, have been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.14, 4.123, 4.124, 4.124a, Diagnostic Code 8526. 5. The criteria for a separate rating for radiculopathy of the left lower extremity, rated as noncompensably disabling, but not higher, beginning April 11, 2014, have been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.14, 4.31, 4.123, 4.124, 4.124a, Diagnostic Code 8526. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty with the United States Army from January 1953 to January 1955. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a February 2010 rating decision of the Department of Veterans Affairs (VA) Regional Office. The Veteran testified before the Board at a February 2017 Travel Board hearing; a transcript of the hearing is associated with the record. This matter was previously before the Board in May 2017 and October 2018. Increased Rating Disability evaluations are determined by comparing a veteran’s present symptomatology with criteria set forth in VA’s Schedule for Rating Disabilities (Rating Schedule), which is based on average impairment in earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. When a question arises as to which of two ratings apply under a particular diagnostic code (DC), the higher evaluation is assigned if the disability more closely approximates the criteria for the higher rating. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the veteran. 38 C.F.R. § 4.3. The veteran’s entire history is reviewed when making disability ratings. See generally 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary concern. “Although a rating specialist is directed to review the recorded history of a disability in order to make a more accurate evaluation, the regulations do not give past medical reports precedence over current findings.” Francisco v. Brown, 7 Vet. App. 55, 58 (1994) (citation omitted). VA accordingly concentrates on the evidence that establishes the state of the veteran’s disability in the period one year before the veteran files his claim through the date VA makes a final decision on the claim. Hart v. Mansfield, 21 Vet. App. 505, 509 (2007). Entitlement to a rating in excess of 40 percent for degenerative disc disease; degenerative joint disease, thoracic spine, is denied. The Veteran contends that he is entitled to a higher rating for degenerative disc disease and degenerative joint disease of the thoracic spine (hereinafter “thoracolumbar spine disability”). The Veteran’s thoracolumbar spine disability is currently rated as 40 percent disabling under DC 5010-5237. Hyphenated DCs are used when a rating under one DC determines its rating based on a residual condition, with the number following the hyphen representing the residual. 38 C.F.R. § 4.27. Diagnostic code 5010 (arthritis, due to trauma, substantiated by x-ray findings) rates disabilities using the classifications of DC 5003 (arthritis, degenerative), which provides two rating options for x-ray-established degenerative arthritis. The first is based on limitation of motion (as classified under the DC for the joint involved) objectively confirmed by findings such as swelling, muscle spasm, or painful motion. The second option under DC 5003 applies where there is no limitation of motion; this option allocates either a 10 percent rating if two or more major joints (or minor joint groups) are involved or a 20 percent rating if the criteria for a 10 percent rating are met and there are occasional incapacitating exacerbations. The DCs that rate the spine on the basis of limitation of motion are DCs 5235 to 5243. 38 C.F.R. § 4.71a. The Veteran’s thoracolumbar spine disability is rated under DC 5237. Under the General Rating Formula for Diseases and Injuries of the Spine, a 10 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height. A 20 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 40 percent rating is warranted for forward flexion of the thoracolumbar spine to 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent evaluation is warranted for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine. Any associated objective neurological abnormalities, including, but not limited to, bowel or bladder impairment, are to be evaluated separately under an appropriate diagnostic code. Id. at Note 1. Unfavorable ankylosis is defined as “a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching.” Id. at Note 5. Additionally, fixation of a spinal segment in neutral position (zero degrees) is “always” considered favorable ankylosis. Id. When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and, therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a; a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) (“[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran’s disability, after which a rating is determined based on the § 4.71a criteria.”). Under 38 C.F.R. § 4.59, painful motion is a factor to be considered with any form of arthritis; however, 38 C.F.R. § 4.59 is not limited to disabilities involving arthritis. See Burton v. Shinseki, 25 Vet. App. 1 (2011). The Board finds that the preponderance of the evidence is against a rating in excess of 40 percent for thoracolumbar spine disability. The Board acknowledges the Veteran’s lay reports of symptoms and that there was functional loss due to pain, including pain during flare-ups, fatigue, and lack of endurance. Even considering the Veteran’s lay reports of symptoms and noted functional loss, however, the degree of additional limitation reflected by the statements that his daily flare-ups would not result in symptoms more nearly approximating unfavorable ankylosis of the entire thoracolumbar spine. VA examinations in December 2008, October 2009, April 2014, August 2017, and April 2019 found that the Veteran had range of motion in the spine. The most restricted movement was shown at the December 2008 VA examination, where the Veteran’s forward flexion was zero to 30 degrees and extension was “only 5 degrees at most.” A November 2011 VA examination listed forward flexion and extension to zero but noted that the “Veteran refuses to attempt forward flexion or extension stating that it is too painful for him to even attempt these movements.” Because the majority of the VA examinations show movement of the spine, with one VA examination lacking results due to the Veteran’s refusal, the Board finds that the preponderance of the evidence shows the Veteran had range of motion in his thoracolumbar spine during the period at issue, which precludes a finding of ankylosis. This is supported by the October 2009, April 2014, August 2017, and April 2019 VA examinations, which all specifically found no ankylosis. The Board acknowledges the Veteran’s report at the November 2011 VA examination that during flare-ups “he is incapable of doing anything during a flare. Pain is so intense that he has to lay in bed and wait for the pain to pass which can take hours to days.” Even when considering the functional limitation during a flare-up, however, the Veteran’s symptoms do not more nearly approximate the entire spine fixed in flexion or extension and one of the additional symptoms set forth in Note 5. Thus, a higher rating is not warranted under the General Rating Formula for Diseases and Injuries of the Spine. Consideration has also been given to assigning a rating under the Formula for Rating Intervertebral Disc Syndrome (IVDS) Based on Incapacitating Episodes. However, the majority of the evidence shows that the Veteran does not have IVDS and the evidence of record is against a finding that the Veteran was ever prescribed bed rest by a physician for a duration that meets the criteria for a higher rating. See 38 C.F.R. § 4.71a, Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes. The October 2009 VA examination found that there were incapacitating episodes due to IVDS but made no reference to physician-prescribed bed rest; instead the VA examination recorded a note from the Veteran’s primary care physician “describing need for short periods of bedrest (which he self-imposes); apparently lasts few hours a few times a week.” In contrast, the November 2011, April 2014, August 2017, and April 2019 VA examinations all found that the Veteran did not have IVDS. Accordingly, a higher rating is not warranted under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes. Turning to neurological impairment, the Veteran is not currently in receipt of any separate disability ratings for neurological impairment associated with the service-connected thoracolumbar spine disability. The Board finds that separate ratings are warranted for neurological deficits of both the right and left lower extremities as due to thoracolumbar spine disability. For the right lower extremity, a separate 10 percent evaluation for mild impairment of the femoral nerve is warranted prior to April 27, 2016, with a noncompensable rating thereafter. As to the left lower extremity, a separate 10 percent evaluation for mild impairment of the femoral nerve is warranted prior to April 11, 2014, with a noncompensable rating thereafter. Paralysis of the anterior crural nerve (femoral) is evaluated in accordance with the criteria set forth in 38 C.F.R. § 4.124a, DC 8526. Under these criteria, mild incomplete paralysis is rated as 10 percent disabling. Moderate incomplete paralysis is rated as 20 percent disabling. Severe incomplete paralysis is rated as 30 percent disabling. Complete paralysis of the quadriceps extensor muscles is rated 40 percent disabling. 38 C.F.R. § 4.124a. The words “mild,” “moderate,” and “severe” as used in the various DCs are not defined in the Rating Schedule. 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. The term “incomplete paralysis” indicates a degree of lost or impaired function substantially less than the type picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating is for the mild, or at most, the moderate degree. The disability ratings for the peripheral nerves are for unilateral involvement; when bilateral, the ratings combine with application of the bilateral factor. 38 C.F.R. § 4.124a, Note at “Diseases of the Peripheral Nerves.” The Note to 38 C.F.R. § 4.124a establishes a maximum disability rating for conditions that are wholly sensory, as opposed to a minimum disability rating for conditions that are more than wholly sensory. See Miller v. Shulkin, 28 Vet. App. 376 (2017). For the lower extremities, the record is mixed for the period prior to April 11, 2014 (left lower extremity) and April 27, 2016 (right lower extremity). A November 2008 VA medical center (VAMC) physical therapy record noted that the Veteran “reports weakness in bil[ateral] top of his legs.” The December 2008 VA examination reported that “The backs of both thighs occasionally get numb. He has occasional lack of feeling in the lower extremities leading occasionally for a tendency for him to stumble but he has not fallen yet.” The October 2009 VA examination likewise noted “Back of legs occasionally numb & caused him to fall other day. No radiating pain through legs, but occasionally into R buttocks”; however, the October 2009 VA examination listed its summary diagnosis as “DDD lumbar spine without radiculopathy.” A March 2010 VAMC record noted that the Veteran complained of “chronic LBP [low back pain] with int numbness in legs, last week legs gave out and he fell.” An April 2010 private medical record indicated that “There is no constant radicular pain in his lower extremities although his legs give out occasionally and therefore he walks with a cane. He notices no weakness.” The November 2011 VA examination found that the Veteran did have “radicular pain or any other signs or symptoms due to radiculopathy” and indicated that the Veteran had “Mild” numbness of the right and left lower extremity. The November 2011 VA examination listed “Numbness to anterior thighs bilaterally, consistent with L2 dermatome” and indicated that the Veteran had “Mild” radiculopathy of the right and left lower extremity. This VA examination found normal muscle strength except for right and left hip flexion, which it found to be 4/5 (“Active movement against some resistance”); no muscle atrophy; normal tendon reflexes; and normal sensory exams except for the left and right upper anterior thigh, which was found to have decreased “sensation to light touch (dermatomes).” In contrast, the April 2014 VA examination noted that the Veteran “does not have any radicular pain but complains of generalized weakness of his lower extremities requiring a walker for the last 5 years.” The April 2014 VA examination found that the Veteran did not have radicular pain or any other signs or symptoms due to radiculopathy. The VA examination found muscle strength test consistently of 4/5 (“Active movement against some resistance”); no muscle atrophy; normal knee reflexes; absent ankle reflexes; and normal sensory exams. A March 2015 VAMC record indicated that the Veteran “states his right leg has numbness and has been dragging the right leg.” In an April 27, 2016 VAMC record, the Veteran denied “numbness, burning or tingling of extremities.” The August 2017 VA examination indicated that the Veteran did not have radicular pain or any other signs or symptoms due to radiculopathy. This VA examination noted no atrophy, muscle strength consistently of 4/5 (“Active movement against some resistance”), normal knee reflexes, absent ankle reflexes, and normal sensory exams. In an April 2018 VAMC record, the Veteran denied “numbness, tingling, headaches or any acute symptoms.” The April 2019 VA examination also found that the Veteran did not have radicular pain or other signs or symptoms due to radiculopathy, further noting “There were no neurological symptoms found to be attributable to his back condition.” This VA examination also found that the Veteran did not have muscle atrophy; his reflex exams were normal, and sensory exams were all normal. Based on the above, the Board finds that the disability is primarily manifest by numbness and weakness for the period prior to April 27, 2016 (right lower extremity) and the period prior to April 11, 2014 (left lower extremity). The Board also finds that during these periods the most probative evidence of record is against a finding that the disabilities were manifest by impairment of sensory disturbance, significant loss of reflexes, muscle atrophy, and complete paralysis. The Board thus finds that the level of impairment for the period prior to April 27, 2016 (right lower extremity) and the period prior to April 11, 2014 (left lower extremity) is most analogous to mild incomplete paralysis. For the periods beginning April 27, 2016 (right lower extremity) and the period beginning April 11, 2014 (left lower extremity), the Board finds that a noncompensable rating is appropriate because the evidence shows no radiculopathy. 38 C.F.R. § 4.31. As to the right lower extremity, the Veteran’s last report of numbness was the March 2015 VAMC record; the remaining relevant records that followed did not find radicular symptoms, including numbness. For the left lower extremity, the last report of symptoms was the November 2011 VA examination; the relevant records that followed did not find radicular symptoms, including numbness. The Board has considered all other potentially applicable DCs, but there is no evidence showing the Veteran has neurological impairment associated with any other peripheral nerves that have not already been service-connected. Therefore, a separate or higher rating under a different DC is not warranted. Regarding additional neurological impairment, such as bowel or bladder conditions, the Veteran asserts that bladder and bowel impairments are related to his thoracolumbar spine disability. While the Veteran is competent to report symptomatology that he experiences, he has not shown that he has the medical experience or training to relate the conditions to his thoracolumbar spine disability, which is a medically complex determination that cannot be based on lay observation alone. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Instead, such a determination must be made by a medical professional with appropriate expertise in the neurological system. Id. Accordingly, the Veteran’s statements that his bowel and bladder conditions are related to his spine condition are not competent evidence and are given no probative weight. In this case, there is no medical evidence associating the Veteran’s bowel or bladder conditions as objective neurologic abnormalities associated with his thoracolumbar spine disability. The October 2009 VA examination provided conflicting findings, stating first that the Veteran was “[h]aving urinary and fecal incontinence” and later indicating that the Veteran had urinary incontinence and obstipation but not fecal incontinence. The October 2009 VA examination found “[o]bstipation related to narcotics” and did not specifically address the causation of urinary incontinence. The November 2011 VA examination found bladder incontinence but no “loss of bowel control.” The VA examination stated that “Etiology of this incontinence is accompanied with urgency indicating nerve sensation is intact and suggest possible prostate problems or urinary retention secondary to narcotic medication unrelated to his back.” The April 2014 and August 2017 examinations found that the Veteran did not have any neurologic abnormalities related to a thoracolumbar spine condition such as bowel or bladder problems. The April 2019 VA examination likewise found that the Veteran did not have any neurologic abnormalities related to thoracolumbar spine condition such as bowel or bladder problems. This VA examination specifically addressed the Veteran’s reported bowel and bladder incontinence, stating “There were no neurological symptoms found to be attributable to his back condition. Any bowel or bladder incontinence is likely due to his age and general debilitation unrelated to his back. He endorsed no radiculopathy or nerve issues down legs and had reasonable range of motion.” Beyond neurologic abnormalities, the Board has also noted the Veteran’s complaint in a June 2010 statement that “The bowel problem stem [sic] from medications for the service connected back and service connected depression.” Again, the Board notes that the Veteran has not demonstrated medical competency to make such a determination (as such a determination requires knowledge of the effects of medications on different bodily systems), nor has he provided evidence to support a connection between his thoracolumbar spine medications and any bowel condition. See Jandreau, 492 F.3d 1376-77. Accordingly, the Board gives the Veteran’s statement no weight. Finally, entitlement to a total disability based on individual unemployability (TDIU) is an additional element of all claims for a higher rating in which the Veteran or the record raises the issue of such entitlement. Rice v. Shinseki, 22 Vet. App. 447 (2009). In this case, the Veteran has been awarded a TDIU effective June 1, 2010. Thus, the Board will address whether an award of TDIU is warranted prior to June 1, 2010, during the appeals period. After considering the evidence, the Board finds that a TDIU is not warranted for the period prior to June 1, 2010. The Board first notes the December 2008 VA examination, which found that the Veteran’s pain “does cause him to be almost completely inactive by his story of spending most of his time sitting or lying down and having to take pretty strong oral pain medication.” Furthermore, the Veteran has noted throughout the appeals period that his condition has worsened, such as in a June 2010 statement. Thus, the Board has also considered later VA examinations, which cover a period in which his symptoms were even worse than the period prior to June 1, 2010; these VA examinations continue to find that the Veteran could perform gainful employment. The November 2011 VA examination noted that “although the Veteran is limited in repetitive lifting, stooping, or bending he is not incapable of gainful employment.” The April 2014 VA examination reported that the Veteran “lives alone, drives, shops, and [sic] his own self-care. He helps with gardening for commercial Enterprises run by his neighbor.” This VA examination indicated that the Veteran’s spine condition affected his ability to work, stating “The veteran has significant degeneration of the spine with osteoporosis which would limit his ability to lift to about 20 pounds occasionally and 5-10 pounds frequently. He has also decreased range of motion which even involves the cervical spine making it difficult for him to drive.” The August 2017 VA examination noted that the Veteran’s thoracolumbar spine disability impacted his ability to work, stating “Standing, walking, bending, lifting all limited. Unable to drive.” When asked to provide a full description of the effects of the Veteran’s thoracolumbar spine disability on his ordinary activities and economic adaptability over the course of the appeal period, the August 2017 VA examination responded “Veteran has gait instability with limited ability to walk, stand, lift, carry, unable to adequately bend forward or twist. Unable to drive a car.” Finally, the April 2019 VA examination reported that The functional impact of his thoracic spine condition is [that he] would have difficulty with leaning forward or lifting weighted objects from the floor or more than 5lbs. No hard or strenuous manual labor that would require carrying weighted objects. However, do feel that his thoracic vertebrae condition is limiting to prolonged standing or walking past 10mins. Best suited for sedentary labor where he can remain seated. Feel that unsteady gait is due to advanced age and generalized deconditioning, not his back condition, which prevents him from walking distances more than 30-50 feet with a walker or prolonged standing past 5-10 mins at a time, and has rendered him best suited for sedentary labor. Considering this evidence, the Board finds that the Veteran was capable of securing and following a substantially gainful occupation during the period prior to June 1, 2010, because, despite his worsening condition, VA examinations consistently found that he was limited in standing, walking, lifting, and bending but allowed for positions in which the Veteran remained seated. Such positions include working in a call center or as a receptionist. Because the Veteran was capable of securing and following a substantially gainful occupation during the period prior to June 1, 2010, the Board finds that entitlement to a TDIU for that period is not warranted. In sum, the preponderance of the evidence is against the Veteran’s claim for a rating in excess of 40 percent for thoracolumbar spine disability. In denying such a rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. The Veteran is entitled, however, to a separate rating for radiculopathy of the right lower extremity, rated as 10 percent disabling prior to April 27, 2016, and noncompensably disabling thereafter. He is also entitled to a separate rating for radiculopathy of the left lower extremity, rated as 10 percent prior to April 11, 2014, and noncompensably disabling thereafter. Duties to Notify and Assist VA has certain duties to notify and assist a veteran in the substantiation of a claim. Pelegrini v. Principi (Pelegrini II), 18 Vet. App. 112, 120–21 (2004), see 38 U.S.C. §§ 5103(a), 5103A; 38 C.F.R. § 3.159. The Veteran, his representative, and the record do not raise any violation of the duty to notify. Thus, the Board finds that VA has complied with its duty to notify. As to the duty to assist, VA is required to make reasonable efforts to help a claimant obtain evidence necessary to substantiate a claim. 38 U.S.C. § 5103A; 38 C.F.R. § 3.159(c), (d). This “duty to assist” contemplates that VA will help a claimant obtain records relevant to a claim, regardless of whether the records are in Federal custody, and that VA will provide a medical examination or obtain an opinion when necessary to decide the claim. 38 C.F.R. § 3.159(c)(4). The Veteran’s representative stated in an October 2018 Written Brief Presentation that the August 2017 VA examination was improper because, in part, it used two identical answers to the Question 4 asking for a “full description of the effects the veterans thoracolumbar spine disability has on ordinary activities and economic adaptability,” including “what limitations might be expected in the workplace” and Question 8 regarding “the effect of the veteran’s service-connected and or claimed disabilities on his or her ability to function in an occupational environment and describe any functional limitations.” The Board finds that an appropriate answer was provided for both questions, as they requested a discussion of the limitations in employment, including functional limitations. The answer, though the same, met the requirements of both questions. In addition, the Veteran submitted a June 2019 statement in which he appears to state that he completed three MRIs and three x-rays of his spine in June 2019. Although VA has a duty to assist the Veteran in obtaining relevant records, the Board finds that that duty is not raised by the Veteran’s June 2019 statement because it provides no information regarding the location of the MRI and x-ray records, such as whether the records are available from a VAMC or private provider.   For the reasons set forth above, the Board finds that VA has complied with the VCAA’s notification and assistance requirements. M. H. HAWLEY Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board W. Ripplinger, 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.