Citation Nr: 21002799 Decision Date: 01/15/21 Archive Date: 01/15/21 DOCKET NO. 18-42 515 DATE: January 15, 2021 ORDER An increased rating of 20 percent, but no higher, for the service-connected lumbosacral spine strain, is granted. REMAND Entitlement to service connection for radiculopathy, left lower extremity (also claimed as pain, weakness of the legs), to include secondary to the service-connected disability of lumbosacral spine strain, is remanded. Entitlement to service connection for radiculopathy, right lower extremity (also claimed as pain, weakness of the legs), to include secondary to the service-connected disability of lumbosacral spine strain, is remanded. FINDING OF FACT For the entire period on appeal, the Veteran’s lumbosacral spine strain manifested in symptoms more nearly approximating constant worsening back pain, forward flexion of the thoracolumbar spine greater than 30 degrees but less than 60 degrees, or total combined range of motion of the thoracolumbar spine not greater than 120 degrees. CONCLUSION OF LAW The criteria for a disability rating of 20 percent but no higher, for the service-connected lumbosacral spine strain have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code (DC) 5237. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from February 2000 to July 2008. This matter is before the Board of Veterans’ Appeals (the Board) on appeal from September 2015 and January 2017 Department of Veterans Affairs (VA) Regional Office (RO) rating decisions. The September 2015 rating decision denied an increased disability rating in excess of 10 percent for the service-connected lumbosacral spine strain. The January 2017 rating decision denied service connection for left lower extremity radiculopathy and right lower extremity radiculopathy (both also claimed as pain, weakness of the legs), as secondary to the service-connected lumbosacral spine strain. With respect to the September 2015 rating decision, the Veteran’s Notice of Disagreement (NOD) was received in July 2016. In July 2018, the RO issued the Statement of the Case, and the Veteran’s VA Form 9, substantive appeal to the Board was received in the same month. With respect to the January 2017 rating decision, the Veteran’s NOD was received in February 2017. The Statement of the Case was issued in March 2019 and the Veteran’s VA Form 9, substantive appeal to the Board was also received in March 2019. Increased Rating Disability ratings are determined by applying the criteria set forth in VA’s Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. See 38 U.S.C. § 1155; 38 C.F.R. § 4.1. In determining the severity of a disability, the Board is required to consider the potential application of various other provisions of the regulations governing VA benefits, whether or not they were raised by the Veteran, as well as the entire history of the Veteran’s disability. 38 C.F.R. §§ 4.1, 4.2; Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991). Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7. Any reasonable doubt regarding a degree of disability will be resolved in favor of the Veteran. 38 C.F.R. § 4.3. 1. Entitlement to an increased rating for the service-connected lumbosacral spine strain. The Veteran seeks an increased rating for the service-connected lumbosacral strain. The Veteran alleges that he sustained the lumbosacral strain during an in-service accident in 2002, and has experienced back pain since, which worsened after service and progressed into degenerative disc disorder (DDD) of the lumbar spine with bilateral lower extremity radiculopathy. The Veteran submitted a private medical opinion indicating that the Veteran’s lumbosacral strain was incorrectly diagnosed. The Veteran’s service-connected lumbosacral strain is rated as 10 percent disabling from June 28, 2008 under 38 C.F.R. § 4.71a, DC 5237. Disabilities rated under DC 5235 to 5242 are rated under the General Rating Formula for Rating Diseases and Injuries of the Spine (General Rating Formula). Spine disabilities are rated under either the General Rating Formula for Diseases and Injuries of the Spine or the Formula for Rating Intervertebral Disc Syndrome (IVDS) based on Incapacitating Episodes, under Diagnostic Code 5243, whichever would result in a higher rating. 38 C.F.R. § 4.71a. Degenerative or traumatic arthritis established by X-ray findings will be rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joints or joint involved; in this case Diagnostic Code 5237. 38 C.F.R. § 4.71a, Diagnostic Codes 5003 and 5010. If a compensable degree of limitation of motion is not shown under the relevant rating criteria for the joint involved (Diagnostic Code 5237), then Diagnostic Code 5003 provides for a 10 percent rating for each such major joint or group of minor joints affected by limitation of motion. In this case, the Veteran’s limitation of motion of the thoracolumbar spine is compensable under Diagnostic Code 5237 pursuant to the General Rating Formula. Accordingly, the assignment of a 10 percent rating for arthritis under Diagnostic Code 5003 is not applicable in this case. The General Rating Formula for Diseases and Injuries of the Spine, with or without symptoms such as pain (whether or not it radiates), stiffness, or aching in the area of the spine affected by residuals of injury or disease, provides the following: A 10 percent rating is assigned when forward flexion of the thoracolumbar spine is greater than 60 degrees but not greater than 85 degrees; or, combined range of motion of the thoracolumbar spine is 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 assigned when forward flexion of the thoracolumbar spine is greater than 30 degrees but not greater than 60 degrees; or combined range of motion of the thoracolumbar spine is 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 assigned when forward flexion of the thoracolumbar spine is 30 degrees or less; or there is favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is assigned when there is unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent rating is assigned for unfavorable ankylosis of entire spine. 38 C.F.R. § 4.71a. The current spine rating criteria instructs the Board to evaluate any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, separately, under an appropriate diagnostic code. See 38 C.F.R. § 4.71a, Note (1). The current spine rating criteria provides specific values for range of motion of the thoracolumbar (thoracic and lumbar) spine. For the thoracolumbar spine, normal forward flexion is 0 to 90 degrees, extension is 0 to 30 degrees, left and right lateral flexion are 0 to 30 degrees, and left and right lateral rotation are 0 to 30 degrees. See 38 C.F.R. § 4.71a, Note (2) (see also Plate V). When rating musculoskeletal disabilities, VA must consider granting a higher rating in cases in which the Veteran experiences functional loss due to limited or excess movement, pain, weakness, excess fatigability, or incoordination (to include during flare-ups or with repeated use), and those factors are not contemplated in the relevant rating criteria. 38 C.F.R. §§ 4.40, 4.45; DeLuca v. Brown, 8 Vet. App. 202, 204-7 (1995). The provisions of 38 C.F.R. § 4.40 and 38 C.F.R. § 4.45 are to be considered in conjunction with the diagnostic codes predicated on limitation of motion. Johnson v. Brown, 9 Vet. App. 7 (1996). In May 2008, the Veteran underwent a general medical examination prior to discharge. The Veteran reported that in 2002, he was jumping off the back of a truck in the rain and fell and hit his back on the tailgate. The Veteran was treated with a muscle relaxer and physical therapy which did not relieve his symptoms. He stated that he has constant low back pain which is exacerbated with physical activities. The Veteran denied that his pain radiated anywhere. He reported his walking being occasionally affected and denied incapacitating episodes. The Veteran reported that his disability does not affect his occupation or activities of daily living. He reported his symptoms being aggravated by physical activity and did not report using an assistive device. The Veteran’s flexion was to 110 degrees, his extension to 30 degrees, lateral flexion to 20 degrees bilaterally, and rotation to 90 degrees bilaterally. Pain was noted with flexion, extension, and right lateral flexion. There was no additional limitation on range of motion with repetitive use. On palpation, there was no spasm, and the Veteran had tenderness in the left lower paraspinal region. Motor function and deep tendon reflexes were intact. Sensation was normal, gait was normal. X-rays of the lumbosacral spine indicated straightening of the spine compatible with spasm. The Veteran was diagnosed with a lumbosacral spine strain. The Veteran’s VA treatment records indicate that he was seen for complaints of low back pain since discharge and continued to receive treatment. An August 2008 VA treatment note indicates that the Veteran was seen in order to establish primary care. He reported having chronic back pain since 2002 following an injury in service. The Veteran reported pain worsening with activities. The Veteran’s pain was treated with medication. There are no records indicating that his back pain resolved. A June 2010 VA treatment note indicates that the Veteran complained of chronic low back pain as well as bilateral ankle and right heel pain. In August 2015, the Veteran underwent a VA examination for his back. He was diagnosed with degenerative arthritis of the spine. The Veteran reported increased frequency of constant pain and stated that he had an MRI that showed bulging disc. The Veteran also reported that he receives no current treatment for his disability and that he has intermittent radiating pain to the left leg down his calf. The Veteran reported that his post-discharge job is a supply technician with duties requiring lots of lifting and moving boxes. He also indicated that he uses a back brace when exercising. The Veteran did not report flare-ups. For range of motion, the Veteran’s forward flexion was to 80 degrees, extension to 30 degrees, right lateral flexion to 30 degrees, left lateral flexion to 30 degrees, right lateral rotation to 30 degrees, and left lateral rotation to 30 degrees. The range of motion was not noted to contribute to functional loss. Pain was exhibited on forward flexion, extension, and right and left lateral rotation. There was evidence of pain with weight bearing. There was no evidence of localized tenderness or pain on palpation of the thoracolumbar spine. The Veteran was able to perform repetitive use testing with no additional loss of function The Veteran was examined immediately after repetitive use over time, and the VA examiner was unable to say without mere speculation whether pain, weakness, fatiguability or incoordination significantly limit functional ability with repeated use over a period of time. There was no guarding or muscle spasm of the thoracolumbar spine and no additional factors noted to contribute to the disability. Muscle strength testing was normal and the Veteran did not have muscle atrophy. Reflex and sensory examinations were normal. Straight leg raising test was normal. The Veteran did not have radicular pain or any other signs or symptoms due to radiculopathy. There was no ankylosis of the spine and no neurologic abnormalities. The Veteran did not have IVDS. The Veteran was noted to occasionally use a back brace for back support. It was noted that imaging studies were performed and there was documented evidence of arthritis. There was no thoracic vertebral fracture with loss of 50 percent or more of height, and no other significant diagnostic test findings. The VA examiner cited the Veteran’s VA treatment records including an August 2008 initial primary care note, a November 2014 primary care note indicating a history of chronic lower back pain, a May 2015 primary care note indicating lower back pain and radiation into lower bilateral extremities with no evidence of radiculopathy, a June 2015 MRI illustrating degenerative findings at L4-L5 and L5-S1 with mild left formal narrowing, a May 2008 imaging study showing straightening of the spine compatible spasm and vertebrae and disc spaces being normal in height. The VA examiner concluded that the Veteran was diagnosed with a lumbar strain, with a not active diagnosis, and degenerative lumbar disc disease at L4-L5 and L5-S1 as being not related to his lumbar strain. The VA examiner indicated that the Veteran’s lumbar spine x-ray was negative for DDD during active duty in 2008. The Veteran was diagnosed with DDD in 2015, 7 years after separation from active duty. The VA examiner noted that the Veteran continues to work as a supply technician, which requires him to lift and carry boxes. The VA examiner also concluded that the Veteran’s limited range of motion and pain with movement without muscle spasm and muscle tenderness is not consistent with lumbar strain. In July 2016, the Veteran underwent a private examination with Dr. P.Y., who was identified as a diagnostic consultant. The private report stated that the intent of the consultation and examination was to assist the Veteran in defining and explaining any applicable injuries and illnesses on which benefits will be applied for. Under low back pain, Dr. P.Y. stated that the diagnosis of lumbosacral strain is grossly incorrect. Dr. P.Y. went on to state that the Veteran suffers from radicular pain and weakness into both lower extremities which by nature is not associated with a strain injury. It was explained that a strain is a minor injury to a muscle and/or tendon which will gradually resolve within a 6 week period and that in this case the Veteran suffers from progressive low back pain which is constant and intensifies on standing, sitting, walking, stairs, and changing positions especially in weight bearing. The Veteran was noted to have weakness of both legs which make stairs particularly problematic. The private report indicated that the Veteran’s low back pain concentrates in the lumbosacral region. Dr. P.Y. noted that the Veteran’s “true lumbar ranges of motion (hips immobile)” are flexion to 20 degrees, extension to 0 degrees, right rotation to 10 degrees, left rotation to 10 degrees, right lateral flexion to 15 degrees, and left lateral flexion to 15 degrees. It was noted that the Veteran had significant loss of the normal mobility of the L5 segment which is concomitant with markedly hypertonic deep and intermediate musculature at that level. Straight leg raise was positive on both sides with cross pain to the left at 20 degrees. Valsalva was positive bilaterally indicating stenosis. Strength of the lower extremities was manually examined and determined to be 50 percent or more weaker than the normal. Dr. P.Y. diagnosed the Veteran with significant extension of service-connected condition of the lower back with chronic discopathy and spinal stenosis added. Dr. P.Y. indicated that diagnostic studies confirming this were on file with the VA. The Veteran was also diagnosed with left sciatic radicular pain and partial paralysis of the left sciatic nerve. Dr. P.Y. stated that it is more likely than not that this disability is directly and causally related to the Veteran’s low back condition and that this is a permanent and progressive condition related to the Veteran’s military service. A September 2016 private treatment note from Waterford Lakes Central Care indicates that the Veteran was seen for back pain which was noted to be severe. The location of the pain was lower back in the midline. The Veteran’s pain radiated to the left calf and was described as aching. The frequency of the symptoms was persistent. The Veteran was diagnosed with midline low back pain with left-sided sciatica. In December 2016, the Veteran underwent a peripheral nerves VA examination. The Veteran reported pain from his lower back to both lower extremities on average being nine-out-of-ten but being ten-out-of-ten on the day of the examination. The Veteran reported that the pain has been slowly progressing since his accident, and is worse sitting for too long, walking a long distance, making it impossible ot bend during morning hours. The Veteran was noted to be taking Motrin for the pain. Under symptoms, it was noted that he had constant severe pain of the bilateral lower extremities and severe paresthesias and numbness of the bilateral lower extremities. Sensory exam indicated decreased sensation in the bilateral upper anterior thigh, bilateral thigh and knee, bilateral leg and ankle, and bilateral toes. The Veteran’s gait was noted to be antalgic. The Veteran contended that he had exacerbated lower back and bilateral sciatic pain. The Veteran was noted to use a back brace regularly. EMG testing was not performed, and the June 2015 MRI of the lumbar spine was cited with evidence of DDD at the L4-L5, L5-S1, and mild left femoral narrowing. The VA examiner indicated that the Veteran came in with an apparent exacerbated pain and asked not to be touched because he was in so much pain. The VA examiner also indicated that physical examination could not be completed and is suboptimal to add to the diagnosis and opinion requested. The Veteran declined to be taken to the clinic and agreed to get medical help for his pain. In January 2017, the Veteran underwent another peripheral nerves VA examination. The Veteran reported that he does not have a diagnosis of bilateral lower extremity radiculopathy and that his Dr., Dr. P.Y. told him that he had radiculopathy. The Veteran reported that he saw Dr. P.Y. at the end of July 2016 and that Dr. P.Y. is a chiropractor who performed a physical examination without any diagnostic testing. The Veteran reported seeing Dr. P.Y. only once. The Veteran reported constant numbness and pain in the bilateral lower extremities, which starts in the lower back and radiates to below his calf. The report indicates that the Veteran has been working as a purchase technician for the Navy since June 2016. The Veteran reported being able to walk approximately half of a mile before having to stop, standing for approximately ten to fifteen minutes before having to lay down, and able to sit for approximately ten to twenty minutes before having to get up stretch. Under symptoms, the Veteran was noted to have severe constant bilateral extremity pain, moderate intermittent bilateral extremity pain, moderate bilateral paresthesias, and severe numbness in the bilateral extremities. The VA examiner noted that these symptoms were subjective complaints. Muscle strength testing was normal and there was no muscle atrophy. Reflex and sensory exams were normal. Under gait, the VA examiner indicated that the Veteran had severe antalgic gait which seemed to significantly improve when the Veteran was walking to his vehicle after the VA examination. The Veteran was noted to continue to walk with a slight limp. The VA examiner indicated that the Veteran’s sciatic nerve, external popliteal nerve, musculocutaneous nerve, anterior tibial nerve, internal popliteal nerve, posterior tibial nerve, anterior crural nerve, internal saphenous nerve, obturator nerve, external cutaneous nerve of the thigh, and ilio-inguinal nerve were all normal. The Veteran was not noted to use any assistive devices for locomotion. The VA examiner concluded that the Veteran’s peripheral nerve conditions did not cause such functional impairment to the lower extremities that no effective function remained. There was no EMG study performed and the June 2015 MRI was cited with evidence of DDD. The VA examiner indicated that there is no scientific medical evidence to support a claim that a musculoskeletal condition such as a back strain or sprain can cause radiculopathy of the bilateral lower extremity. The VA examiner also indicated that the Veteran saw Dr. Y.P. once with no diagnostic testing. At the outset, rating the Veteran’s service-connected lumbosacral spine strain is complicated by the 2015 diagnosis of DDD of the lumbar spine. The Court has held that if it is not possible to separate the effects of service-connected from non-service-connected disables, all symptoms must be attributed to the service-connected condition. Mittleider v. West, 11 Vet. App. 181, 182 (1998). Therefore, in rating the Veteran’s back disability, unless it has been made apparent in the clinical reports which symptoms are attributable to the service-connected lumbosacral strain versus the non-service connected DDD of the lumbar spine, all symptoms will be attributed to the Veteran’s service-connected lumbosacral back strain. In this case, the August 2015 VA examiner indicated that the Veteran’s service-connected lumbar strain was not an active diagnosis and that his lumbar DDD was not related to his lumbar strain. By contrast, the July 2016 private examination report by Dr. P.Y. indicated that the Veteran’s service-connected back disability worsened to include chronic discopathy with spinal stenosis. While there is conflicting evidence as to whether the Veteran’s subsequently diagnosed lumbar spine DDD is related to his service-connected lumbosacral strain, and whether the Veteran was actually diagnosed with stenosis, the record in this matter makes no distinction between the Veteran’s symptoms. Particularly, the Veteran consistently reported having back pain which has gotten worse since his 2002 injury and was noted during his May 2008 separation examination. His VA treatment records contain consistent reports of worsening back pain since discharge. The August 2015 VA examiner indicated that the Veteran’s lumbar strain resolved itself. However, the initial injury was in 2002, and the Veteran still complained of back pain in May 2008, approximately six years after his strain was diagnosed. No explanation was provided as to when the back strain resolved, and whether the Veteran’s low back pain which lasted from discharge to present was related to the service-connected back strain or the lumbar DDD. Interestingly, the August 2015 VA examiner cited to August 2008, November 2014, and May 2015 VA treatment notes indicating that the Veteran complained of back pain and concluded that the current back pain was consistent with DDD of the lumbar spine. The VA examiner also indicated that May 2008 x-rays of the spine were clear for DDD and that DDD was not diagnosed until 2015. There is a clear record of the Veteran having continuous back pain prior to the 2015 DDD diagnosis, and no distinction was made as to whether the pain that was documented up to 2015 was attributed to the Veteran’s service-connected lumbosacral back strain or the subsequently diagnosed lumbar DDD. In this case, no medical provider has specifically distinguished the pain associated with the Veteran’s lumbar strain and pain from lumbar DDD. When it is not possible to separate the effects of service-connected and non-service-connected disabilities, such effects should be attributed to the service-connected condition. Mittleider v. West, 11 Vet. App. 182. Such is the case here. Because no distinction was made between the symptoms of the Veteran’s lumbosacral strain and lumbar DDD, all symptoms associated with the Veteran’s lumbar spine are considered in rating his service-connected disability. Based on the review of the entire record, the Veteran’s service-connected lumbar strain symptoms most closely approximate the criteria for a 20 percent disability rating for the entire period on appeal. The evidence reflects progressive and constant back pain, intensifying with standing, sitting, walking, stairs, and changing positions, especially with weight bearing. There is conflicting evidence with respect to limitation in the range of motion of the Veteran’s back. During the Veteran’s August 2015 VA examination, forward flexion was recorded at 80 degrees, and the total combined range of motion of the thoracolumbar spine was 230 degrees. That notwithstanding, the July 2016 private examination report from Dr. P.Y. indicates that the Veteran’s “true lumbar ranges of motion (hips immobile)” were flexion to 20 degrees and total combined range of motion of the thoracolumbar spine to 70 degrees. However, the July 2016 private examination report does not provide the metrics used in measuring these results. It is unclear what Dr. P.Y. meant by “true” lumbar range of motion or why the results were starkly different from the August 2015 VA examination. For example, the Veteran’s extension was measured at 0 degrees, and it is unclear whether the Veteran was able to complete the entire extension range of motion or was not able to move at all. The July 2016 private report also does not contain any diagnostic testing. For example, Dr. P.Y. indicated that the Veteran had stenosis based on Valsalva, or a breathing technique. Given that July 2016 findings did not provide a metric or an explanation for how range of motion limitation was measured and did not provide any diagnostic testing, the particular diagnostic results as well as range of motion readings are not afforded probative value and are outweighed by range of motion test results in the August 2015 VA examination report. However, in this case the Veteran’s reported symptoms are of such the severity and frequency, that the overall disability picture more closely approximates the symptoms encompassed by the criteria for a 20 percent disability rating. In other words, given the Veteran’s competent reports of constant pain worsening with walking and standing, it is likely that the his range of motion of the thoracolumbar spine more closely approximates forward flexion greater than 30 degrees but not greater than 60, and total combined range of motion of the cervical spine not greater than 170 degrees, when considering additional motion loss following overactivity or during flare-ups. Additionally, there is no indication of muscle spasm or guarding severe enough to result in abnormal gait or abnormal spinal contour. A rating in excess of 20 percent is not warranted at any time during the appeal period under DC 5237. The record does not reflect either (i) favorable ankylosis of the entire thoracolumbar spine or (ii) forward flexion of the thoracolumbar spine limited to 30 degrees or less. Therefore, the criteria for the assignment of a rating in excess of 20 percent under DC 5237 have not been met or approximated at any time during the appeal period. Likewise, the Veteran is not entitled to a rating in excess of 20 percent under the Formula for Rating IVDS Based on Incapacitating Episodes as the evidence indicates that the Veteran does not suffer incapacitating episodes of IVDS requiring physician-prescribed bedrest as a result. See 38 C.F.R. § 4.71a, DC 5243, Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes. Staged ratings are not warranted for the Veteran’s back disability as his symptoms remained largely the same throughout the period on appeal. With respect to an evaluation for any associated neurological abnormalities, the claims for service connection are discussed below. In sum, the criteria for the assignment of a 20 percent disability rating, but no higher, for the service-connected lumbosacral strain for the entire period on appeal is warranted. REASONS FOR REMAND 2. Entitlement to service connection for right lower extremity radiculopathy (also claimed as pain, weakness of the legs), associated with service-connected lumbosacral strain. 3. Entitlement to service connection for left lower extremity radiculopathy (also claimed as pain, weakness of the legs), associated with service-connected lumbosacral strain. The Veteran seeks service connection for bilateral lower extremity radiculopathy and alleges that his disabilities are a result of his service-connected lumbosacral strain. The Veteran’s VA treatment records and private treatment records do not contain diagnostic testing for lower extremity radiculopathy. His VA treatment records contain complaints of low back pain radiating down to the legs and a September 2016 private treatment note from Waterford Lakes Central Care indicates that the Veteran had midline low back pain with sciatica. These records do not definitively establish a diagnosis of radiculopathy or provide a basis upon which to assess the severity of any associated nerve dysfunction. As discussed above, the Veteran submitted a July 2016 private examination report from Dr. P.Y. indicating that he suffers from bilateral lower extremity radicular pain and partial paralysis of the sciatic nerve. However, no diagnostic testing or EMG was conducted in support of this diagnosis, and the severity of any such radicular symptoms cannot be established from these findings. In December 2016, the Veteran underwent a VA examination for peripheral nerves. The examination could not be completed because the Veteran requested not to be touched due to exacerbated lower back and bilateral sciatic pain. In January 2017, the Veteran underwent another VA examination for peripheral nerves. That examination did not include an EMG, and the VA examiner did not provide a definite diagnosis, noting only that a back strain or sprain cannot cause radiculopathy. Neither VA examination is adequate. With regard to the January 2017 examiner’s comment, the Board has already established that, pursuant to this decision, the effects of the Veteran’s non-service-connected lumbar spine DDD are considered in evaluating his service-connected back strain. Moreover, as noted above, the current spine rating criteria requires a separate evaluation for any associated objective neurologic abnormalities separately, under an appropriate diagnostic code. See 38 C.F.R. § 4.71a, Note (1). As such, the January 2017 VA medical opinion is incomplete, as a definite diagnosis based on clinical testing is necessary to determine whether the Veteran has radiculopathy, and if that radiculopathy is associated with his spine disability. Thus, the record in this matter is incomplete and does not allow for a proper adjudication of the claim. When medical evidence is inadequate, VA must supplement the record by seeking an advisory opinion or ordering another medical examination. Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991); Hatlestad v. Derwinski, 3 Vet. App. 213, 216 (1992). Of note, under 38 C.F.R. § 3.655, the Veteran is required to report and comply with a scheduled VA examination. In the event the Veteran fails to do so, the claim shall be decided based on the existing evidence of record. Accordingly, the matter is remanded for further development and adjudication. The matter is REMANDED for the following action: 1. Obtain all outstanding VA treatment records related to the Veteran’s claimed bilateral lower extremity radiculopathy; and, with appropriate authorization, obtain any private treatment records identified by the Veteran as pertinent to this claim, and associate them with the claims file. 2. Schedule the Veteran for an examination to determine whether the Veteran has bilateral lower extremity radiculopathy associated with his service-connected back disability. All indicated testing should be conducted, including, if possible, MRI and/or EMG testing to provide a definitive diagnosis and to allow for an accurate measurement of the level of severity. The VA examiner is requested to review all pertinent records associated with the claims file, including a copy of this remand. The VA examiner is requested to opine as to: (a.) Whether the Veteran has a current diagnosis of right and/or left lower extremity radiculopathy associated with his current lumbar spine disability, to include the Veteran’s DDD. (b.) In the event the Veteran does have a diagnosis of right and/or left lower extremity radiculopathy, please indicate the severity in terms of the rating schedule, for each affected lower extremity. (c.) The VA examiner is requested to provide a full rationale for all opinions provided. L. B. CRYAN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Kuksova, Kseniya 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.