Citation Nr: 21076125 Decision Date: 12/22/21 Archive Date: 12/22/21 DOCKET NO. 17-20 825 DATE: December 22, 2021 ORDER Prior to May 23, 2021, entitlement to a rating in excess of 20 percent, and no higher, for a lumbar spine disability is granted. Since May 23, 2021, entitlement to a rating of 40 percent, and no higher, for a lumbar spine disability is granted. REMANDED Entitlement an initial rating in excess of 20 percent for radiculopathy (femoral nerve) of the right lower extremity is remanded. Entitlement an initial rating in excess of 10 percent for neuropathy of the right lower extremity is remanded. Entitlement an initial rating in excess of 10 percent for neuropathy of the left lower extremity is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. FINDINGS OF FACT 1. Prior to May 23, 2021, the Veteran's lumbar spine disability resulted in functional impairments that equates to flexion limited to 60 degrees. 2. Since May 23, 2021, the Veteran's lumbar spine disability resulted in functional impairments that equates to flexion limited to 30 degrees. CONCLUSIONS OF LAW 1. Prior to May 23, 2021, the criteria are met for a rating of 20 percent for a lumbar spine disability. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, DC 5242-5237. 2. Since May 23, 2021, the criteria are met for a rating of 40 percent for a lumbar spine disability. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, DC 5242-5237. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from December 1982 to April 1987, and from December 1987 to August 2003. In March 2020, the Veteran attended a Travel Board hearing. A copy of the transcript has been associated with the claims file. This matter was previously remanded by the Board in October 2020. The requested development in that remand has been completed. Increased Ratings Disability ratings are determined by the application of a schedule of ratings that is based on average impairment of earning capacity. 38 U.S.C. § 1155 (West 2012). Percentage ratings are determined by comparing the manifestations of a particular disability with the requirements contained in VA's Schedule for Rating Disabilities. The percentage ratings contained in the Rating Schedule represent, as far as can practically be determined, the average impairment in earning capacity resulting from a disease or injury and the residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. If two ratings are potentially applicable, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. In view of the number of atypical instances, it is not expected, especially with the more fully described grades of disabilities, that all cases will show all the findings specified. 38 C.F.R. § 4.21. It is the defined and consistently applied policy of VA to administer the law under a broad interpretation, consistent with the facts shown in every case. Any reasonable doubt regarding the degree of disability is resolved in favor of the Veteran. 38 C.F.R. § 3.102, 4.3. In deciding this appeal, the Board has considered whether separate ratings for different periods of time are warranted, a practice of assigning ratings referred to as staging ratings. See Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2008). 1. Lumbar Spine The Veteran is presently in receipt of a 20 percent rating for the lumbar spine, pursuant to diagnostic code (DC) 5242-5237. He is seeking a higher rating. The Veteran filed for an increased rating for this disability on September 30, 2014. Therefore, the relevant temporal focus is from September 30, 2013, one year prior to the date of receipt of the claim for an increased rating. Based on DC 5242 VA is to rate the Veteran 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. 38 C.F.R. § 4.71a, DCs 5237-5243 (2020). Under 38 C.F.R. § 4.71a, DCs 5235 to 5243, spine disorders are to be rated under the General Rating Formula for Diseases and Injuries of the Spine on the basis of limitation of motion. Under these diagnostic codes, a 10 percent rating is assigned when rating 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 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; when the combined range of motion of the thoracolumbar spine is not greater than 120 degrees; or when there is muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. 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 thoracolumbar spine only. Finally, a 100 percent rating is assigned when there is unfavorable ankylosis of the entire spine. As described above, the higher rating for 50 percent requires unfavorable ankylosis of the entire thoracolumbar spine. 38 C.F.R. § 4.71, Diagnostic Code 5242. The Court, citing Dorland's Illustrated Medical Dictionary (28th ed. 1994), has recognized that ankylosis is defined as "immobility and consolidation of a joint due to disease, injury or surgical procedure," for VA compensation purposes. See Colayong v. West, 12 Vet. App. 524, 528 (1999). The General Rating Formula for Diseases and Injuries of the Spine, provides further guidance in rating diseases or injuries of the spine. In pertinent part, Note (1) provides that any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, should be rated separately under an appropriate diagnostic code. Note (2) provides that, for VA compensation purposes, normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, left and right lateral flexion are zero to 30 degrees, and left and right lateral rotation are zero to 30 degrees. The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined range of motion of the thoracolumbar spine is 240 degrees. The normal ranges of motion for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion. See also Plate V, 38 C.F.R. § 4.71a. Effective February 7, 2021, VA's Schedule, 38 C.F.R. Part 4, was amended with regard to rating musculoskeletal disorders. Fed. Reg. 76453 (November 30, 2020) (codified at 38 C.F.R. § 4.71a). When a law or regulation changes during the course of a claim or an appeal, the version more favorable to the veteran will apply, to the extent permitted by any stated effective date in the amendment in question. VAOPGCPREC 3-2000; Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). The revised musculoskeletal regulations do not provide for retroactive application; thus, the amendments may be applied as of, but not prior to, February 7, 2021. Hence, VA has made clear that its intent is that the claims pending prior to the effective date will be considered under both old and new rating criteria, and whatever criteria is more favorable to the Veteran will be applied. For applications filed on or after the effective date, only the new criteria will be applied. As the Veteran's claim was pending prior to February 7, 2021, the Board will consider entitlement under the prior regulations as well as the updated regulations from February 7, 2021 forward, applying the most favorable criteria for the Veteran. The changes effective February 7, 2021 under 38 C.F.R. § 4.71a, DC 5242 and 5243 were not to the rating schedule itself but added instruction to classify disabilities associated with IVDS under DC 5243 and all other intervertebral disc disabilities under 5242. As such, DC 5242 now reflects "Degenerative arthritis, degenerative disc disease other than intervertebral disc syndrome (also, see either DC 5003 or 5010);" DC 5243 now reflects "Intervertebral disc syndrome: Assign this diagnostic code only when there is disc herniation with compression and/or irritation of the adjacent nerve route; assign diagnostic code 5242 for all other disc diagnoses." As such, the changes do not impact the general rating formula and evaluation of the disability under the pre-and post-February 7, 2021 regulations is not required. Factual Evidence The Veteran was first examined by VA in January 2015, in connection with the claim for an increased rating for the lumbar spine disability. See January 2015 VA Back Conditions Disability Benefits Questionnaire (DBQ). At that time, the Veteran reported suffering from flare-ups, which he described as due to muscle spasms, resulting in sharp pain that lasts 1 to 2 hours. The Veteran also reported functional loss/ impairment due to his lumbar spine disability in that he is unable to lift over 10 pounds, cannot reach above his shoulders, and he has to think prior to making movements, which slows him down. Range of motion testing of the lumbar spine revealed flexion to 70 degrees, extension to 15 degrees, right and left lateral flexion to 20 degrees, and right and left lateral rotation to 15 degrees. The examiner noted that the Veteran was limited from prolonged bending, and there was pain in all directions resulting in functional loss. Also, on examination, there was no evidence of pain on weight bearing, but the Veteran did have localized tenderness or pain on palpation. The Veteran was able to perform repetitive use testing with at least three repetitions, with no additional loss of function or range of motion. The examiner stated that he was unable to say whether pain, weakness, fatigability or incoordination significantly limited functional ability with repeated use over a period of time, as only 3 repetitions were observed. As for flare-ups, the Veteran described the frequency as occurring 2 to 3 times a week, lasting 1 to 2 hours, and moderate severity. However, again, the examiner was unable to say whether pain, weakness, fatigability or incoordination significantly limited functional ability during a flare-up as the Veteran was not examined during one. There was evidence of guarding and muscle spasms, but not resulting in abnormal gait or abnormal spinal contour. Additional contributing factors to the disability included disturbance of locomotion, interference with sitting, interference with standing, and no prolonged sitting or standing. Muscle strength, reflexes, and sensory examination were all normal. Further, straight leg raising test was negative bilaterally. During this examination, the examiner did not find any signs or symptoms of radiculopathy, neuropathy, ankylosis, IVDS, or any other neurological abnormalities. Finally, as for functional impairments, the examiner again noted the limitations with standing, lifting, reaching over his shoulders, pushing and pulling, and problems bending. The Veteran was next examined by VA to ascertain the severity of his lumbar spine disability in a June 2017. See June 2017 VA Back Conditions DBQ. At that time, the Veteran again reported suffering from flare-ups, but a description was not provided and any functional limitations/ impairments not specified. Range of motion testing of the lumbar spine revealed flexion to 65 degrees, extension to 20 degrees, right and left lateral flexion to 20 degrees, and right and left lateral rotation to 20 degrees. The examiner noted there was pain in all directions, but not resulting in functional loss. There was evidence of pain on weight bearing, but no evidence of localized tenderness or pain on palpation. Further, the examiner found evidence of pain on passive range of motion, but not non-weight bearing. The Veteran was able to perform repetitive use testing with at least three repetitions, with no additional loss of function or range of motion. The examiner stated pain, weakness, fatigability or incoordination did not significantly limit functional ability with repeated use over a period of time. As for flare-ups, the examiner was unable to say whether pain, weakness, fatigability or incoordination significantly limited functional ability during a flare-up as the Veteran was no examined during one, but the examiner stated the examination was consisted with the Veteran's statements. Also, on examination, there was no evidence of guarding and muscle spasms. Additional contributing factors to the disability included disturbance of locomotion, interference with sitting, interference with standing, and instability of station. Muscle strength examination was normal, but deep tendon reflexes were found to be 1+, bilaterally. Sensory examination revealed decreased sensation to light touch in the upper anterior thighs, bilaterally. Straight leg raising test was negative bilaterally, however, the examiner found evidence of mild pain, paresthesias/ dysesthesias, and numbness, bilaterally. There was no evidence of ankylosis, IVDS, or any other neurological abnormalities. The Veteran required the occasional use of a cane. Finally, as for functional impairments, the examiner again noted the limitations with standing, lifting, reaching over his shoulders, pushing and pulling, and problems bending. The Veteran was next examined by VA in October 2017. See October 2017 VA Back Conditions DBQ. During this examination, it was noted the Veteran underwent a spinal fusion in June 2017. The Veteran denied suffering from flare-ups, but described functional limitations/ impairments as being unable to work and do things like "check air in the tire." Range of motion testing of the lumbar spine revealed flexion to 60 degrees, extension to 15 degrees, right and left lateral flexion to 10 degrees, right lateral rotation to 15 degrees, and left lateral rotation to 10 degrees. The examiner noted there was pain in all directions except extension, but not resulting in functional loss. The examiner then noted that the Veteran could not fully bend at the waist and was limited in his ability to turn in any direction at the waist. There was no evidence of pain on weight bearing, and no evidence of localized tenderness or pain on palpation. The Veteran was able to perform repetitive use testing with at least three repetitions, with no additional loss of function or range of motion. The examiner stated a determination as to whether pain, weakness, fatigability or incoordination significantly limited functional ability with repeated use over a period of time or during a flare-up could not be made as it was not observed. Also, on examination, there was evidence of guarding that resulted in abnormal gait or abnormal spine contour, resulting in the Veteran walking with hyperextension. Additional contributing factors to the disability included interference with standing as he cannot stand or walk for prolonged periods of time. Muscle strength examination was 4/5 on the right side and normal on the left. Sensory examination revealed decreased sensation in the foot and lower leg, bilaterally. There was no evidence of muscle atrophy. Straight leg raising test was negative bilaterally, however, the examiner found evidence of moderate paresthesias/ dysesthesias, bilaterally. The examiner noted impairment of the femoral nerve in the right lower extremity, and impairment of the sciatic nerve, bilaterally. The examiner noted the severity of radiculopathy in the right lower extremity was found to be moderate, and mild in the left. There was no evidence of ankylosis, IVDS, or any other neurological abnormalities. The examiner noted that the Veteran does have a scar in the midline of the lower back, measuring 5.5 centimeters (cm) by 0.5, but it was not found to be painful or unstable. A second scar was noted as vertical, superficial, and measuring 3 cm. Finally, as for functional impairments, the examiner again noted the limitations with prolonged standing or walking, bending at the waist and lifting objects from the ground. As for the Correia requirements, there was no objective evidence of pain on non-weight bearing, and passive range of motion for the back was found to be the same as active motion. In support of his claim, the Veteran submitted a private back conditions DBQ, dated in December 2020. See December 2020 private Back Conditions DBQ. The Veteran reported flare-ups, which resulted in increased pain, decreased function and ability to do activities of daily living. As for function loss or impairment, he reported decreased sitting, standing, and ability to lift. Range of motion testing of the lumbar spine revealed flexion to 60 degrees, extension to 10 degrees, right and left lateral flexion to 20 degrees, and right and left lateral rotation to 20 degrees. Pain resulted in functional loss. The physician noted that the Veteran was not able to perform repetitive use testing due to his prior fusion. The physician noted pain on active motion, passive motion, and weight-bearing all resulting in functional loss or additional limitation of motion, and tenderness to palpation. Any additional range of motion findings were not provided. Also on examination, there was evidence of guarding and muscles spasms, but it did not result in abnormal gait or abnormal spine contour. Additional contributing factors to the disability included less movement than normal, weakened movement, and interference with sitting/ standing. Muscle strength, deep tendon reflex, and sensory examinations were all normal. There was no evidence of muscle atrophy. Straight leg raising test was positive bilaterally, with evidence of moderate intermittent pain, and mild paresthesias/ dysesthesias, bilaterally. The physician noted moderate impairment of the sciatic nerve, bilaterally. There was no evidence of ankylosis, or bowel or bladder impairment. Further, on examination, IVDS was noted to be present, but result in less than 1 week total duration of incapacitating episodes over the past 12 months. The physician also indicated the presence of multiple surgical scars, found to have a total are less than 39 cm squared. Finally, the Veteran was most recently examined by VA in a May 2021 VA Back Conditions DBQ. The Veteran reported an increase in pain and the need for another surgery. He reported suffering from daily flare-ups, lasting 16 or more hours a day, characterized by sharp, stabbing pain. He reported that the flare-ups result in increased pain, weakness to the left leg which causes him to fall, and a decrease in function. Also due to his lumbar spine disability, the Veterans is unable to stand, sit, or walk for long periods of time, and has difficulty bending and squatting. Range of motion testing of the lumbar spine revealed flexion to 40 degrees, extension to 10 degrees, right and left lateral flexion to 10 degrees, and right and left lateral rotation to 20 degrees. The examiner noted there was pain in all directions, but not resulting in any additional decrease in range of motion. functional loss. There was evidence of pain on weight bearing, non-weight bearing, active motion, passive motion, and at rest, causing function loss in difficulty bending, squatting, and walking or standing for long periods of time. There was also evidence of tenderness to palpation. The Veteran was able to perform repetitive use testing with at least three repetitions, with no additional loss of function or range of motion. Pain and weakness were noted to cause functional loss. During a flare-up, the examiner noted pain and weakness resulted in functional loss, with a decrease in range of motion. Specifically, flexion was found to be to 35 degrees, extension to 10 degrees, and right and left lateral rotation and flexion were all found to be to 10 degrees. Also, on examination, there was evidence of guarding, that did not result in abnormal gait or abnormal spine contour. There was no evidence of muscle spasms. Additional contributing factors to the disability include less and weakened movement. Muscle strength examination was 4/5 on the left side and normal on the right. Sensory examination revealed decreased sensation in the foot and lower leg, bilaterally. There was no evidence of muscle atrophy. Straight leg raising test was positive bilaterally. The examiner found evidence of mild pain, numbness, and paresthesias/ dysesthesias, bilaterally. The examiner noted impairment of the sciatic nerve, bilaterally. There was no evidence of ankylosis, or bowel or bladder impairments. IVDS was found to be present, resulting in incapacitating episodes having a total duration of at least 1 week but less than 2 weeks in the last 12 months. The examiner noted that the Veteran does have a scar measuring 7 cm by 0.1 cm., but no other comment was provided. Additionally, the Veteran's VA and private treatment records show his continuous and extensive treatment and complaints of pain associated with the low back disability throughout the pendency of the appeal. However, there are no objective range of motion findings or clinical findings in these treatment records that are materially different from the objective findings noted in the VA examinations as discussed above. Legal Analysis Appellate Period - Prior to May 23, 2021 The Board notes that a Veteran may be entitled to a higher disability evaluation for a musculoskeletal disability than that supported by mechanical application of the rating schedule where there is evidence that his or her disability causes additional functional loss, such as the inability... to perform the normal working movements of the body with normal excursion, strength, speed, coordination[,] and endurance, including as due to pain. 38 C.F.R. § 4.40 (2020); see Lyles v. Shulkin, 29 Vet. App. 107, 117 (2017). A higher disability evaluation may also be awarded where there is a reduction of a joint's normal excursion of movement in different planes, including changes in the joint's range of movement, strength, fatigability, or coordination. 38 C.F.R. § 4.45 (2020). However, the veteran's functional loss must result in limitation of motion sufficient to satisfy the next disability rating allowable for that particular disorder to be entitled to a higher disability rating under §§ 4.40 and 4.45. See Thompson v. McDonald, 815 F.3d 781, 785-86 (Fed. Cir. 2016). Here, with respect to functional loss, the January 2015, June 2017, and October 2017 VA examination reports and the December 2020 private examination all noted pain, flare-ups, and significant limitations/ functional limitations due to the lumbar spine disability. Specifically, all examinations noted limitations with standing, sitting, bending, lifting, reaching over his shoulders, and pushing and pulling. See June 2017 VA Back Conditions DBQ. Additionally, the October 2017 VA examiner noted the Veteran could not fully bend at the waist and was limited in his ability to turn in any direction at the waist. The December 2020 private physician noted that the Veteran's pain resulted in functional loss, and the Veteran was not able to perform repetitive use testing due to his prior fusion. Importantly, no additional range of motion values were presented during flare-ups and after repetitive use testing where pain was shown to result in functional loss. Therefore, resolving all doubt in the Veteran's favor, the Board finds that when considering the functional limitations due to the lumbar spine disability, to include consideration of the criteria in DeLuca v. Brown, 8 Vet. App. 202 (1995), Mitchell v Shinseki, 25 Vet. App. 32 (2011), Correia v. McDonald, 28 Vet. App. 158 (2016), Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Veteran's functional loss equates to the criteria required for the next higher 20 percent rating when considering the cumulative picture of his lumbar spine disability. Appellate Period - Since May 23, 2021 For the period since May 23, 2021, the Board finds a rating of 40 percent is warranted. Specifically, the May 2021 VA Back Conditions DBQ noted flexion to 40 degrees but, during a flare-up, the Veteran's flexion decreased to 35 degrees. Additionally, during flare-ups and following repetitive use testing, pain and weakness were noted to cause functional loss. Further, the Board has considered the criteria as identified in Sharp and Correia with specific consideration of flare-ups and pain. Here, the Veteran reported suffering from daily flare-ups, lasting 16 or more hours a day, characterized by sharp, stabbing pain. He reported that the flare-ups result in increased pain, weakness to the left leg which causes him to fall, and a decrease in function. Also due to his lumbar spine disability, the Veteran is unable to stand, sit, or walk for long periods of time, and has difficulty bending and squatting. See May 2021 VA Back Conditions DBQ. Therefore, when considering the above, the Veteran's functional loss equates to the criteria required for the next higher 40 percent rating when considering the cumulative picture of his lumbar spine disability. DeLuca v. Brown, 8 Vet. App. 202 (1995), Mitchell v Shinseki, 25 Vet. App. 32 (2011), Correia v. McDonald, 28 Vet. App. 158 (2016), Sharp v. Shulkin, 29 Vet. App. 26 (2017). Finally, while the Veteran has reported flare-ups, there is no indication he suffered from such restricted range of motion of the lumbar spine that it may be considered the functional equivalent of ankylosis. See Chavis v. McDonough, No. 18-2928 (April 16, 2021); see also January 2015, June 2017, October 2017, May 2021 VA Back Conditions DBQs, and December 2020 Private Back Conditions DBQ. There is no other medical evidence, aside from what has been discussed in detail above, which would support the Veteran's contentions that his lumbar spine disability has increased in severity beyond the now 20 percent rating prior to May 23, 2021 and 40 percent since at any point during the appeals period. In addition to considering the orthopedic manifestations of a lumbar spine disability, VA regulations also require that consideration be given to any associated objective neurologic abnormalities, which are to be evaluated separately under an appropriate diagnostic code. Here, the Veteran is already in receipt of service connection for right lower extremity radiculopathy and right and left lower extremity neuropathy, which is addressed in the remand portion below. There are no other neurological impairments, such as bowel or bladder impairment, that warrants separate ratings. See again January 2015, June 2017, October 2017, and May 2021 VA Back Conditions DBQs, and December 2020 private back conditions DBQ. In reaching the above conclusions, the Board has not overlooked the Veteran's statements and March 2020 Board hearing testimony with regard to the severity of his lumbar spine disability. In this regard, the Veteran is competent to report on factual matters of which he has firsthand knowledge, e.g., experiencing chronic pain in his back, or experiencing a worsening of that pain. See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005). The Veteran has provided lay evidence through written statements and during his prior Board hearing throughout the course of this appeal with respect to the presence of pain and the severity of such during his VA examinations. He is competent to provide such statements, and the Board finds that the Veteran's statements are credible. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Nevertheless, the Board finds the Veteran's statements are not indicative of symptomatology that is more severe than that observed at his VA examinations and do not describe symptoms that would warrant a higher rating than what is currently assigned. As such, the objective medical findings provided by the Veteran's VA examination reports have been accorded greater probative weight. See Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993). Therefore, the evidence supports the assignation of a 20 percent rating prior to May 23, 2021, and a rating of 40 percent since. However, as a preponderance of the evidence is against the award of a ratings in excess of 20 percent for the lumbar spine disability prior to May 23, 2021 and 40 percent since, the benefit-of-the-doubt doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107(b); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1991). REASONS FOR REMAND 1. Radiculopathy (femoral nerve) of the right lower extremity, and bilateral lower extremity neuropathy The Veteran seeks increased initial ratings for right leg lumbar radiculopathy of the femoral nerve, rated under Diagnostic Code 8726, and increased initial ratings for bilateral lumbar neuropathy of the sciatic nerve, rated under Diagnostic Code 8720. However, the record does not reflect that the symptoms of right leg radiculopathy of the femoral nerve have been differentiated from the symptoms of bilateral lower extremity neuropathy of the sciatic nerve. In fact, the October 2017 VA Back Conditions DBQ indicates there is overlap at the L4 for both the sciatic and femoral nerves. This differentiation is key as the critical element in permitting the assignment of several ratings under various diagnostic codes is that none of the symptomatology for any one of the conditions is duplicative or overlapping with the symptomatology of the other condition); Lyles v. Shulkin, 29 Vet. App. 107 (2017) (holding that 38 C.F.R. § 4.14 prohibits compensating a veteran twice for the same symptoms or functional impairment). Thus, remand for a medical opinion on this matter is warranted. 2. TDIU Consideration of entitlement to a TDIU in this matter is dependent upon the impact of the Veteran's service-connected disabilities on his ability to obtain or retain substantially gainful employment. Accordingly, the matter of a TDIU is inextricably intertwined with the Veteran's claims remanded herein. Harris v. Derwinski, 1 Vet. App. 180 (1991). Remand of the inextricably intertwined TDIU claim is, thus, also required. The matters are REMANDED for the following action: 1. Obtain any additional records relevant to the remaining claims on appeal not currently associated with the claims file. 2. Then, schedule the Veteran for a VA examination with an appropriate specialist to determine the current severity of his right lower extremity lumbar radiculopathy of the femoral nerve and bilateral lower extremity lumbar neuropathy of the sciatic nerve. The Veteran's claims folder must be reviewed by the examiner in conjunction with the examination. The examiner should describe the functional impact of the Veteran's neurological impairments in the right and left lower extremities on both the sciatic nerve and the femoral nerve. Specifically, the examiner should explain whether the effects of the radiculopathy and neuropathy can be differentiated between the nerves, and, if so, to assess the severity of the symptoms as applied to each nerve. Specifically address if the symptomatology are on separate branches. A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. 5. THE AOJ MUST REVIEW THE CLAIMS FILE AND ENSURE THAT THE FOREGOING DEVELOPMENT ACTION HAS BEEN COMPLETED IN FULL. IF ANY DEVELOPMENT IS INCOMPLETE, APPROPRIATE CORRECTIVE ACTION MUST BE IMPLEMENTED. IF ANY REPORT DOES NOT INCLUDE ADEQUATE RESPONSES TO THE SPECIFIC OPINIONS REQUESTED, IT MUST BE RETURNED TO THE PROVIDING EXAMINER FOR CORRECTIVE ACTION. YVETTE R. WHITE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Berry, 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.