Citation Nr: 21001709 Decision Date: 01/11/21 Archive Date: 01/11/21 DOCKET NO. 16-55 300 DATE: January 11, 2021 ORDER For the entire period on appeal, entitlement to a rating of 70 percent, but no higher, for posttraumatic stress disorder (PTSD), with depression, neurocognitive disorder, and alcohol abuse (effective October 4, 2010, excluding the period in which a total rating is assigned), is granted. For the entire period on appeal, entitlement to a rating of 40 percent, but no higher, for degenerative joint disease, degenerative disc disease, status post lumbar laminectomies and fusion (lumbar spine disability) (effective July 24, 2012), is granted. REMANDED Entitlement to a rating higher than 20 percent for radiculopathy of the right lower extremity is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. FINDINGS OF FACT 1. Throughout the appeal period, the Veteran’s symptoms of PTSD, with depression, neurocognitive disorder, and alcohol abuse, more nearly approximate occupational and social impairment with deficiencies in most areas; his symptoms do not more nearly approximate total occupational and social impairment. 2. Throughout the appeal period, the Veteran’s lumbar spine disability was manifested by a painful reduced range of motion, failed lumbar spine fusion and implanted spinal cord stimulator; it is not manifested by unfavorable ankylosis of the entire thoracolumbar spine and the Veteran did not have incapacitating episodes due to intervertebral disc syndrome having a total duration of at least 6 weeks during the past twelve months. CONCLUSIONS OF LAW 1. For the entire period on appeal, the criteria for entitlement to a rating of 70 percent, but no higher, for PTSD with depression, neurocognitive disorder, and alcohol abuse (effective October 4, 2010, excluding the period in which a total rating is assigned), have been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1-4.14, 4.130, Diagnostic Code 9411. 2. For the entire period on appeal, the criteria for entitlement to a rating of 40 percent, but no higher, for the Veteran’s lumbar spine disability (effective July 24, 2012) have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5243. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from July 1997 to May 2005. This matter comes before the Board of Veterans’ Appeals (BVA or Board) from an August 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran requested a hearing before the Board. The requested hearing was conducted in September 2019 by the undersigned Veterans Law Judge. A transcript is associated with the claims file. In January 2020, the Board remanded these claims for additional development. In an August 2020 rating decision, the RO granted an increased evaluation of 70 percent for PTSD, effective March 2020 and 40 percent for his lumbar spine disability, effective March 2020. Despite the grant of these increased evaluations, the Veteran has not been awarded the highest possible evaluations. As a result, he is presumed to be seeking the maximum possible evaluations. The issues remain on appeal, as the Veteran has not indicated satisfaction with the ratings assigned. A.B. v. Brown, 6 Vet. App. 35 (1993). In the August 2020 rating decision, the RO also granted separate service connection for left femoral and left sciatic radiculopathy and painful back surgical scars. The Veteran has not expressed disagreement with the ratings or effective dates assigned for these disabilities; these issues are not before the Board. See Waddell v. Wilkie, No. 17-0438, 2018 U.S. App. Vet. Claims LEXIS 1463 (Nov. 1, 2018) (unpublished single-judge disposition); John v. Shulkin, No. 16-2487, 2018 U.S. App. Vet. Claims LEXIS 116 (Jan. 31, 2018) (unpublished single-judge disposition); see also Bethea v. Derwinski, 2 Vet. App. 252, 254 (1992) (a non-precedential decision may be cited for any persuasiveness or reasoning it contains). Increased Ratings The Veteran seeks entitlement to increased ratings for his acquired psychiatric disorder and lumbar spine disability. Disability ratings are based on the average impairment of earning capacity resulting from disability. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities. Where there is a question as to which of two evaluations shall be applied, the higher evaluations will be assigned if the disability more closely approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The Veteran’s entire history is to be considered when making disability evaluations. See generally 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). Where entitlement to compensation already has been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). The Board has considered the entire record, including the Veteran’s VA clinical records and private treatment records. These show complaints and treatment but will not be referenced in detail. The Federal Circuit has held that the Board must review the entire record but does not have to discuss each piece of evidence. Gonzales v. West, 218 F.3d 1378 (Fed. Cir. 2000). Therefore, the Board will discuss the evidence pertinent to the rating criteria and the current disabilities. 1. Entitlement to a rating higher than 50 percent for PTSD with depression, neurocognitive disorder, and alcohol abuse, prior to March 20, 2020, and to a rating higher than 70 percent, thereafter. The Veteran seeks a higher rating for his service-connected acquired psychiatric disorder. Service connection for PTSD was established by a December 2011 rating decision, at which time it was noted to be evaluated with already service-connected adjustment disorder with depressed mood. An evaluation of 50 percent was assigned effective October 4, 2010, a 100 percent rating assigned from November 23, 2010 due to hospitalization over 21 days, and a rating of 50 percent was assigned from January 1, 2011. Service connection for dementia was also granted at that time, effective January 24, 2011 and was evaluated with the service-connected PTSD. The Veteran submitted a claim for TDIU, which was considered a claim for increased ratings for all service-connected disabilities, in July 2012. In an August 2013 rating decision, the RO continued the Veteran’s 50 percent evaluation. A notice of disagreement with the rating assigned was received in July 2014. In an August 2020 rating decision, the RO granted an increased evaluation of 70 percent for PTSD, effective March 2020. The current regulations establish a general rating formula for mental disorders. 38 C.F.R. § 4.130. Ratings are assigned according to the manifestation of particular symptoms. However, the use of the term “such as” 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 the symptoms, or their effects, that would justify a particular rating. Mauerhan v. Principi, 16 Vet. App. 436 (2002). Accordingly, the evidence considered in determining the level of impairment under 38 C.F.R. § 4.130, Diagnostic Code 9411, is not restricted to the symptoms provided in the diagnostic code. Instead, VA must consider all symptoms of a Veteran's condition that affect the level of the Veteran's occupational and social impairment, including, if applicable, those identified in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.) (DSM-V). Id. As noted, the Veteran is rated as 50 percent disabled due to his PTSD, prior to March 2020, and as 70 percent disabled, thereafter. A rating of 50 percent is warranted when there is 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 (retention of only highly learned material, forgetting to complete tasks); impaired judgment, impaired abstract thinking; disturbances of motivation and mood; and difficulty establishing and maintaining effective work and social relationships. A 70 percent evaluation is warranted where there is objective evidence demonstrating that the Veteran has occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to suicidal ideation; obsessional rituals which interfere with his routine activities, speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately, or 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; and the inability to establish and maintain effective relationships. A 100 percent evaluation is warranted for 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. Having carefully considered the Veteran's lay contentions in light of the evidence of record and the applicable law, the Board finds that the overall evidence shows that the Veteran's disability more closely approximates a 70 percent disability rating for the entire appeal period. The Board finds the Veteran exhibits symptoms that demonstrate occupational and social impairment with deficiencies in most areas, including impaired impulse control, unprovoked irritability with periods of violence, difficulty in adapting to stressful circumstances, and severe difficulty establishing and maintaining effective relationships. The Board notes that the Veteran has a long history of irritability and periods of violence. Historically, it was reported in VA treatment notes that in December 2010 the Veteran was in an altercation with his father, at which time he broke a beer bottle and ripped off his father’s ear; at the time, he endorsed significant depression and anger problems. Similarly, in a January 2011 VA examination, it was noted that he had physically assaulted others, including an ex-girlfriend, that he faced charges for assault with a deadly weapon, and he had irritability with severe outbursts of anger. In a March 2013 VA examination, he continued to endorse irritability, severe outbursts of anger, and obsessional rituals that interfered with his daily activities. Similarly, in a December 2013 letter, a private psychologist stated the Veteran has severe problems with impulse control and can quickly decompensate in pressured situations. The psychologist indicated the Veteran is viewed as a risk to others and has problems with concentration and executive function. In a March 2020 VA examination, the Veteran exhibited symptoms of irritability, short temper, depressed mood and impulsivity. The Veteran reported previously pulling a firearm and shooting into the sky, for which he served 14 months of a 36-month sentence. He endorsed symptoms such as irritable behavior and angry outbursts, hypervigilance, exaggerated startle response, problems with concentration, sleep disturbance, panic attacks more than once weekly, and the examiner noted that the Veteran’s mood was mildly irritable during examination. The Board has considered the testimony from September 2019 indicating the Veteran continues to exhibit severe outbursts of anger and irritability, obsessional rituals, panic attacks and difficulty maintaining relationships. Additionally, the Board has considered the lay statements of record, including statements submitted by the Veteran’s family members, friends, and coworkers describing his PTSD symptoms and the effect on his life. Overall, the Veteran's symptoms, particularly his near-constant depression, impaired impulse control, unprovoked irritability with periods of violence, difficulty in adapting to stressful circumstances, and severe difficulty establishing and maintaining effective relationships more nearly approximate a 70 percent rating, throughout the period on appeal. The Board, however, does not find that the Veteran is entitled to a 100 percent disabling rating because the evidence does not suggest a total occupational and social impairment. He has not exhibited symptoms such as memory loss for his name or names of close relatives, or disorientation to time or place. The Veteran has been consistently well groomed, and oriented to time, place and person during examinations. The Veteran has consistently denied suicidal ideations, and the evidence indicates the Veteran is not in persistent danger of hurting himself. Additionally, although the Veteran has difficulty maintaining relationships, he continues to have a relationship with his daughter, and has remarried his second wife. See March 2013 VA examination; March 2020 VA examination. Regarding employment, as recently as the March 2020 VA examination, the Veteran indicated that although he essentially works alone in an office requiring little interaction with others, he is currently employed. The Board finds the Veteran has not exhibited total occupational and social impairment at any time during the appeal period. Based on the overall evidence of record, including the lay statements of record, the effects of the Veteran's symptoms are of a type, frequency, and severity that are in accord with the level of impairment contemplated by the criteria for a rating of 70 percent, but no higher, for the entire appeal period. In making this determination, the Board has considered the Veteran’s statements and all reasonable doubt has been resolved in favor of the Veteran. See Gilbert, 1 Vet. App. at 55. As new and material evidence (a claim for TDIU in July 2012) was received within a year of the December 2011 rating decision, this evidence is considered as having been filed in connection with the claim that was pending at the beginning of the appeal period. 38 C.F.R. § 3.156(b) (2018). Accordingly, the appropriate effective date for the 70 percent rating is October 4, 2010. 2. Entitlement to a rating higher than 20 percent for degenerative disc disease, degenerative joint disease, status post lumbar laminectomies and fusion, prior to March 23, 2020, and to a rating higher than 40 percent, thereafter. The Veteran seeks entitlement to an increased rating for his lumbar spine disability. Service connection for a lumbar spine disability was established by July 2005 rating decision, at which time a 40 percent rating was assigned, effective May 2005. In an October 2009 rating decision, the Veteran’s rating was reduced to 20 percent, effective June 22, 2009. In July 2012, a claim for entitlement to a TDIU was received, which was considered a claim for increase for all service-connected disabilities. The Veteran’s 20 percent rating was continued in an August 2013 rating decision; a notice of disagreement was received in July 2014. In an August 2020 rating decision, the RO granted an increased rating of 40 percent, effective March 2020. The basis of disability evaluations is the ability of the body as a whole to function under the ordinary conditions of daily life, including employment. 38 C.F.R. § 4.10. Disability of the musculoskeletal system is primarily the inability to perform the normal working movements of the body with normal excursion, strength, speed, coordination and endurance. 38 C.F.R. § 4.40. Consideration is to be given to whether there is less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, pain on movement, swelling, deformity or atrophy of disuse, instability of station, or interference with standing, sitting, or weight bearing. Under 38 C.F.R. § 4.59, painful motion is an important factor of joint disability and actually painful joints are entitled to at least the minimum compensable rating for the joint. This regulation also requires that, whenever possible, the joints involved are tested for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with the range of the opposite undamaged joint. See Correia v. McDonald, 28 Vet. App. 158, 168 (2016). Under 38 C.F.R. §§ 4.40 and 4.45, a Veteran’s pain, swelling, weakness, and excess fatigability must be considered when determining the appropriate evaluation for a disability using the limitation of motion Diagnostic Codes. See Johnson v. Brown, 9 Vet. App. 7, 10 (1996). The Court held in DeLuca that all complaints of pain, fatigability, etc., shall be considered when put forth by a Veteran. Therefore, consistent with DeLuca and 38 C.F.R. § 4.59, the Veteran’s complaints of pain have been considered in the Board’s review of the Diagnostic Codes for limitation of motion. In Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Court addressed what constitutes an adequate explanation for an examiner’s inability to estimate motion loss in terms of degrees during periods of flare-ups. The Court held that a VA examiner must attempt to elicit information from the record and the Veteran regarding the severity, frequency, duration, or functional loss manifestations during flare-ups before determining that an estimate of motion loss in terms of degrees could not be given. It also held that any inability to furnish such an estimate must be predicated on a lack of medical knowledge among the medical community at large, rather than insufficient knowledge by the individual examiner. Id. The Veteran’s lumbosacral spine disability is rated under 38 C.F.R. § 4.71a, Diagnostic Code 5243, General Rating Formula for Diseases and Injuries of the Spine. A 20 percent rating is warranted when there is forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, 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 rating of 40 percent is warranted when there is forward flexion of the thoracolumbar spine to 30 degrees or less or favorable ankylosis of the entire thoracolumbar spine. A rating of 50 percent is warranted for unfavorable ankylosis of the entire thoracolumbar spine and a rating of 100 percent is warranted for unfavorable ankylosis of the entire spine. Any associated objective neurologic abnormalities should be evaluated separately, under an appropriate diagnostic code. Alternatively, the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes allows a rating of 20 percent when there are incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months. A 40 percent rating 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, and a rating of 60 percent is warranted when there are incapacitating episodes having a total duration of at least 6 weeks during the past 12 months. Prior to March 23, 2020, the Veteran is rated as 20 percent disabled. The Veteran was afforded a VA examination in March 2013. The examination report indicates the Veteran had a flexion of more than 75 degrees with a note stating “as noticed as vet stood up the chair & examination table,” with objective evidence of pain at 45 degrees, and extension to 30 degrees or greater, with objective evidence of pain at 30 degrees. Ranges of motion were the same after repetitive-use testing and the Veteran denied having flare-ups. There was no evidence of incapacitating episodes over the prior twelve months. The examiner indicated that the claims file was not available for review and stated that the examination report should not be held to “CPEP quality indicators regarding record review.” During the September 2019 Board hearing, the Veteran testified that during the 2013 VA examination, he was asked to bend over, and when he could not, he was pushed into the chair and asked to touch the back of the chair. The Veteran’s representative argued that the March 2013 VA examination was not adequate because the examiner did not review the claims file and did not consider the overall function of the Veteran’s spine, instead focusing solely on range of motion. The Veteran’s representative argued that the March 2013 VA examiner failed to note that the Veteran’s spinal fusion surgery had failed and that he also had a spinal cord stimulator implanted in his back. Resolving all reasonable doubt in his favor, the Board finds that a 40 percent rating is warranted for the Veteran’s lumbar spine disability, for the entire period on appeal. The Board acknowledges the inadequacies of the March 2013 VA examination, to include a lack of file review, and despite the range of motion results from the March 2013 VA examination, the record indicates that the Veteran’s lumbar spine disability is severe enough to warrant an implanted spinal cord stimulator. Additionally, a May 2014 VA treatment note indicates the Veteran’s lumbar spine fusion surgery in 2011 was not successful and imaging demonstrated a non-union of his prior fusion of L5-S1. The Veteran testified that his prior surgery in 2011 did not provide any relief and he continues to experience severe pain. A rating higher than 40 percent, however, is not warranted. As noted, under the General Rating Formula for Diseases and Injuries of the Spine, a higher 50 percent rating is warranted only when there is unfavorable ankylosis of the thoracolumbar spine, or a 100 percent rating is warranted when there is unfavorable ankylosis of the entire spine. See 38 C.F.R. § 4.71a. Generally, ankylosis is stiffening or fixation of the joint as the result of a disease process, with fibrous or bony union across the joint. Dinsay v. Brown, 9 Vet. App. 79, 81 (1996) citing Dorland’s Illustrated Medical Dictionary at 86 (27th ed. 1988) (Ankylosis is “immobility and consolidation of a joint due to disease, injury, or surgical procedure.”); see also Coyalong v. West, 12 Vet. App. 524, 528 (1999). Note (5) of the General Rating Formula states that, for VA compensation purposes, unfavorable ankylosis is a condition in which the thoracolumbar 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 of 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 a neutral position (zero degrees) always represents favorable ankylosis. In this case, there have been no findings of ankylosis. In the March 2020 VA examination, although limited, the Veteran’s lumbar spine had a range of motion, and it was specifically noted that he did not have ankylosis. There are no additional treatment records indicating ankylosis. Therefore, a rating higher than 40 percent under the General Rating Formula is not warranted. Also, the Board notes that the criteria for a 40 percent rating includes compensation for favorable ankylosis. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. See 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine, Note (5). Thus, the 40 percent rating currently assigned presently contemplates episodes in which the Veteran believes his disability is so severe that he cannot move his back. Unfavorable ankylosis, as contemplated in the 50 percent and 100 percent ratings, however, is a condition 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. See 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine, Note (5). The Board does not find that the medical evidence or the Veteran’s lay description of the functional impairment he experiences during any flare-ups demonstrates the level of disability associated with unfavorable ankylosis of the thoracolumbar spine, which is the criteria associated with the next higher rating of 50 percent. Alternatively, the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes allows for a higher 60 percent rating if the Veteran’s lumbar spine condition results in incapacitating episodes having a total duration of 6 weeks during a 12-month period. 38 C.F.R. § 4.71a. However, the evidence does not reflect that the Veteran was prescribed bed rest for his lumbar spine condition. For example, during the March 2020 VA examination, the examiner noted that the Veteran was not diagnosed with intervertebral disc syndrome and there is no evidence that the Veteran was prescribed bed rest by a physician for at least 6 weeks during the prior year. In reaching these conclusions, the Board has considered any additional functional limitation due to factors such as pain, weakness, incoordination, or fatigability. See 38 C.F.R. §§ 4. 40 and 4.45; Deluca v. Brown. In considering additional limitation of function, the Board acknowledges the Veteran’s complaints of pain. These complaints are well documented in the Veteran’s written statements and treatment records and statements submitted by friends and family members. Additionally, the Board notes the Veteran’s testimony in September 2019 that his spinal fusion surgery failed, and he continues to experience pain. This evidence has been considered in the assigment of the now 40 percent rating for the entire appeal period. As such, the Veteran is receiving the maximum disability rating for limitation of motion for the entire period on appeal, and therefore, 38 C.F.R. §§ 4. 40 and 4.45 are not applicable. Johnston v. Brown, 10 Vet. App. 80, 85 (1997). Finally, the General Rating Formula for Diseases and Injuries of the Spine provides that VA is to evaluate any associated objective neurologic abnormalities associated with a service-connected spinal disability under an appropriate diagnostic code. See 38 C.F.R. § 4.71a, Note 1. Here, the Veteran has denied any bladder or bowel problems, throughout the appeal period; therefore, separate ratings are not warranted. The Board notes that the Veteran is separately service connected for radiculopathy of the left lower extremity; however, as noted in the introduction, this rating is not currently on appeal. Entitlement to an increased rating for radiculopathy of the right lower extremity is addressed in the remand section below. For all these reasons, a rating of 40 percent, but no higher, for the entire appeal period is granted. In making this determination, the Board has considered the Veteran’s statements and all reasonable doubt has been resolved in favor of the Veteran. See Gilbert, 1 Vet. App. at 55. REASONS FOR REMAND 3. Entitlement to a rating higher than 20 percent for radiculopathy of the right lower extremity. The Veteran seeks an increased rating for his radiculopathy of the right lower extremity, currently rated as 20 percent disabling under Diagnostic Code 8520. Under Diagnostic Code 8520, a 10 percent rating is warranted for mild incomplete paralysis; 20 percent is warranted for moderate incomplete paralysis; a 40 percent rating is warranted for moderately severe incomplete paralysis; a 60 percent rating is warranted for severe incomplete paralysis with marked muscular atrophy; and a maximum 80 percent rating is warranted for complete paralysis. 38 C.F.R. § 4.124a, Diagnostic Code 8520. The terms “mild,” “moderate,” “moderately severe,” and “severe” are not defined in the regulations. Rather than applying a mechanical formula, the Board must evaluate all of the evidence. 38 C.F.R. § 4.6. The April 2020 VA examination for radiculopathy used the Disability Benefits Questionnaire (DBQ) for the Spine and the option for assessing the symptoms as “moderately severe” was not available to the examiner in that DBQ form. Because the severity of moderately severe is of particular importance in this case given the Veteran’s current 20 percent rating, on remand, the Veteran should be afforded a peripheral nerves examination. The examination report must include the category of “moderately severe” for the sciatic nerve as a possible severity. 4. Entitlement to a TDIU. The Board finds that the issue of entitlement to a TDIU is inextricably intertwined with the pending increased rating claim. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (noting that two issues are inextricably intertwined when the adjudication of one issue could have significant impact on the other issue). Therefore, a decision on this claim is being deferred pending completion of the development ordered on remand to avoid piecemeal adjudication. The matters are REMANDED for the following action: Afford the Veteran a VA peripheral nerves examination to determine the current severity of his radiculopathy of the right lower extremity. *The examination form must include the category of moderately severe as a possible severity for the sciatic nerve. The Veteran’s claims folder must be reviewed by the examiner. The examiner should identify and completely describe all current symptomatology. TANYA SMITH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board L. Andersen, 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.