Citation Nr: 21008107 Decision Date: 02/11/21 Archive Date: 02/11/21 DOCKET NO. 19-19 853 DATE: February 11, 2021 ORDER Prior to July 18, 2018, a rating in excess of 20 percent for a thoracolumbar spine disorder is denied. Since July 18, 2018, a rating in excess of 40 percent for a thoracolumbar spine disorder is denied. An increased rating of 20 percent for right lower extremity radiculopathy is granted. An increased rating of 20 percent for left lower extremity radiculopathy is granted. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is granted effective July 18, 2018. REMANDED Entitlement to a compensable rating for bowel and bladder disturbance associated with the Veteran’s thoracolumbar spine disorder is remanded. Prior to July 18, 2018, entitlement to TDIU on an extraschedular basis is remanded. THE VETERAN’S CONTENTIONS The Veteran seeks higher ratings for his thoracolumbar spine condition and entitlement to TDIU. See July 2018 notice of disagreement (NOD); March 2019 NOD; May 2019 VA Form 9; April 2020 VA Form 9. He contends that his service-connected back disorder, MDD, and tinnitus prevent him from securing or following a substantially gainful occupation and that he last worked in July 1999 as an entertainment motor coach driver. He notes that he had to leave his position after pain and decreased function of his legs made it too painful and dangerous to safely operate vehicles. See June 2019 Veteran’s application for increased compensation based on unemployability. In November 2020, the Veteran specifically asserted that TDIU on an extraschedular basis is warranted. See November 2020 statement. He stated that his service-connected lower back disabilities and bilateral lower extremity radiculopathy support entitlement to TDIU in and of themselves. See July 2020 correspondence; September 2018 statement. In regard to his thoracolumbar spine disability, the Veteran contends that higher ratings should be assigned for urinary incontinence and neurological issues. See December 2019 statement. FINDINGS OF FACT 1. Prior to July 18, 2018, the Veteran’s thoracolumbar spine disorder was productive of, at worst, forward flexion of 60 degrees, without ankylosis or incapacitating episodes with a total duration of at least 4 weeks during the previous 12 months due to intervertebral disc syndrome. 2. Since July 18, 2018, the Veteran’s thoracolumbar spine disorder is productive of forward flexion of less than 30 degrees, without ankylosis or incapacitating episodes with a total duration of at least 4 weeks during the previous 12 months due to intervertebral disc syndrome. 3. Throughout the appeal period, the Veteran’s right lower extremity radiculopathy has been characterized by moderate incomplete paralysis of the sciatic nerve. 4. Throughout the appeal period, the Veteran’s left lower extremity radiculopathy has been characterized by moderate incomplete paralysis of the sciatic nerve. 5. Since July 18, 2018, it is reasonably shown that the Veteran’s service-connected disabilities preclude him from securing or following a substantially gainful occupation. 6. Prior to July 18, 2018, the Veteran did not have one disability ratable at 60 percent or more; nor did he have at least one disability ratable at 40 percent or more and a combined disability rating of 70 percent. CONCLUSIONS OF LAW 1. Prior to July 18, 2018, the criteria for a rating in excess of 20 percent for a thoracolumbar spine disorder are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.21, 4.40, 4.45, 4.59, 4.71a; DCs 5235-5243. 2. Since July 18, 2018, the criteria for a rating in excess of 40 percent for a thoracolumbar spine disorder are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.21, 4.40, 4.45, 4.59, 4.71a; DCs 5235-5243. 3. Throughout the appeal period, the criteria for entitlement to an increased rating of 20 percent, but no higher, for radiculopathy of the right lower extremity are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.124a, DC 8520. 4. Throughout the appeal period, the criteria for entitlement to an increased rating of 20 percent, but no higher, for radiculopathy of the left lower extremity are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.124a, DC 8520. 5. Since July 18, 2018, the criteria for assignment of TDIU due to the Veteran’s service-connected disabilities are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the Air Force from November 1982 to May 1985. This matter is on appeal from January 2018 and January 2019 rating decisions from the Department of Veterans Affairs (VA) Regional Office (RO). In October 2019, these issues were remanded by the Board. An April 2020 rating decision increased the Veteran’s evaluation for a thoracolumbar spine condition to 20 percent effective September 22, 2005 and 40 percent effective July 18, 2018 and granted service connection for radiculopathy of the left and right lower extremities, each with a 10 percent rating effective September 22, 2005. 1. Prior to July 18, 2018, a rating in excess of 20 percent for a thoracolumbar spine disorder is denied. The Veteran’s thoracolumbar spine disorder is rated 20 percent disabling prior to July 18, 2018 under DC 5242. Disability ratings are determined by applying the rating criteria set forth in VA's Schedule for Rating Disabilities (Rating Schedule) and represent the average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The basis of disability evaluations is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment. 38 C.F.R. § 4.10. 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 compensation as well as the whole recorded history of the Veteran's disability. 38 C.F.R. §§ 4.1, 4.2; see generally Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability more closely approximates the criteria for that rating. 38 C.F.R. § 4.7. Otherwise, the lower rating is assigned. Id. Additionally, while it is not expected that all cases will show all the findings specified, findings sufficiently characteristic to identify the disease and the disability therefrom and coordination of rating with impairment of function will be expected in all instances. 38 C.F.R. § 4.21. The Board has considered whether separate ratings for different periods of time are warranted based on the facts, which is a practice of assigning ratings that is referred to as “staging the ratings.” Fenderson v. West, 12 Vet. App. 119 (1999). The criteria for rating all disabilities of the spine are set forth in 38 C.F.R. § 4.71a, which provides that spine disabilities are to be evaluated either under the General Rating Formula for Diseases and Injuries of the Spine (General Formula) or under the Formula for Rating IVDS Based on Incapacitating Episodes (IVDS Formula), whichever method results in the higher evaluation when all disabilities are combined under 38 C.F.R. § 4.25. Under the IVDS Formula, a spine disability is rated based on the presence of incapacitating episodes, which are periods of acute signs and symptoms due to IVDS that require bed rest prescribed by a physician and treatment by a physician. 38 C.F.R. § 4.71a, IVDS Formula. The General Formula for rating a disability of the spine provides in pertinent part: 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, a 20 percent evaluation is warranted for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees, or the combined range of motion of the thoracolumbar spine 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 evaluation is warranted for forward flexion of the thoracolumbar spine to 30 degrees or less, or favorable ankylosis of the entire thoracolumbar spine; a 50 percent evaluation is warranted for unfavorable ankylosis of the entire thoracolumbar spine; and a 100 percent evaluation is warranted for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, General Formula. The notes listed below apply to the General Rating Formula for Diseases and Injuries of the Spine: Note (1) Evaluate any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, separately, under an appropriate diagnostic code. Note (2): For VA compensation purposes, normal forward flexion of the thoracolumbar spine 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. 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. Note (3): In exceptional cases, an examiner may state that because of age, body habitus, neurologic disease, or other factors not the result of disease or injury of the spine, the range of motion of the spine in a particular individual should be considered normal for that individual, even though it does not conform to the normal range of motion stated in Note (2). Provided that the examiner supplies an explanation, the examiner’s assessment that the range of motion is normal for that individual will be accepted. Note (4): Round each range of motion measurement to the nearest five degrees. Note (5): For VA compensation purposes, unfavorable ankylosis 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. Fixation of a spinal segment in neutral position (0 degrees) always represents favorable ankylosis. Under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes (IVDS), a 60 percent disability rating is warranted when there are incapacitating episodes having a total duration of at least six weeks during the past 12 months. A 40 percent rating is warranted when there are incapacitating episodes having a total duration of at least four weeks, but less than six weeks during the past 12 months. For purposes of evaluation under Diagnostic Code 5243 (Intervertebral Disc Syndrome), an incapacitating episode is a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician. 38 C.F.R. § 4.71a, The Spine, Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, Note (1). If intervertebral disc syndrome is presented in more than one spinal segment, provided that the effects in each spinal segment are clearly distinct, evaluate each segment on the basis of incapacitating episodes, or under the General Rating Formula for Diseases and Injuries of the Spine, whichever method results in a higher evaluation for that segment. 38 C.F.R. § 4.71a, The Spine, Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, Note (2). The rating criteria for IVDS were amended, effective February 7, 2021. See 85 Fed. Reg. 76453 (February 7, 2021) (codified at 38 C.F.R. § 4.71a). The revised criteria provide that a rating under DC 5243 for IVDS is assigned only when there is disc herniation with compression and/or irritation of the adjacent nerve root; and that DC 5242 be assigned for all other disc diagnoses. When amended regulations expressly state an effective date and do not include any provision for retroactive applicability, application of the revised regulations prior to the stated effective date is precluded. 38 U.S.C. § 5110(g); DeSousa v. Gober, 10 Vet. App. 461, 467 (1997); VAOPGCPREC 3-2000. Therefore, as the amendment discussed above has a specified effective date without provision for retroactive application, the amendment may not be applied prior to its effective date. As of the effective date, February 7, 2021, the Board must apply whichever version of the rating criteria is more favorable to the Veteran. Although the record documents continued complaints of back pain, the Board finds that an increased rating of 40 percent rating is not warranted under the General Rating Formula. An August 2005 private treatment record showed forward flexion 60 degrees, extension 15 degrees, and lateral flexion 20 degrees on each side. See August 2005 private treatment record. An October 2010 VA back examination showed no incapacitating episodes of spine disease; no ankylosis; and forward flexion of 70 degrees. The Veteran reported no flareups. The June 2014 Disability Benefits Questionnaire (DBQ) shows forward flexion of 90 degrees with no objective evidence of painful motion, and the Veteran reported no flareups. The examiner also noted there was no ankylosis and no intervertebral disc syndrome. As forward flexion during this period measured greater than 30 degrees and there is no evidence of ankylosis, a rating in excess of 20 percent is not warranted under the General Rating Formula prior to July 18, 2018. Notwithstanding that the VA examinations and other physical examinations discussed above failed to test passive range of motion and range of motion in non-weight-bearing conditions, the Board finds that the examinations nevertheless are adequate for VA rating purposes. Passive range of motion is the amount of motion possible when an examiner moves a body part with no assistance from the individual being evaluated. It is usually greater than active range of motion because the integrity of the soft tissue structures does not dictate the limits of movement. Comparisons between passive range of motion and active range of motion provide information about the amount of motion permitted by the associated joint structures (passive range of motion) relative to the individual’s ability to produce motion at a joint (active range of motion). CYNTHIA NORKIN & D. JOYCE WHITE, MEASUREMENT OF JOINT MOTION: A GUIDE TO GONIOMETRY 8-9 (2016). Testing the joint under weight-bearing conditions involves movement of the body against gravity. J. Randy Jinkins, et. al., Upright, Weight-bearing, Dynamic-kinetic Magnetic Resonance Imaging of the Spine: Initial Results, 15 J. Eur. Radiol. 1815-25 (2005). When evaluating range of motion, it is preferable to test in weight-bearing conditions because testing in non-weight-bearing conditions underestimates the degree of pathology present. Id. at 1823. Because there is no indication that the structural integrity of the Veteran’s back is compromised, such that passive range of motion in this case would be more limited than active, and because testing in weight-bearing conditions is more demonstrative of the degree of pathology, the Board finds that the failure to test for limitation of motion on passive range of motion and in non-weight-bearing is not prejudicial. In regard to IVDS, the Board notes that the evidence shows a diagnosis of “intervertebral disc disorders”. See March 2011 VA treatment record. However, there is no evidence showing that this disorder was productive of incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks in a 12-month time period as required for a higher rating prior to July 18, 2018. 38 C.F.R. § 4.71a, DC 5243. In sum, a rating in excess of 20 percent for a thoracolumbar spine disorder is not warranted prior to July 18, 2018. 2. Since July 18, 2018, a rating in excess of 40 percent for a thoracolumbar spine disorder is denied. The Veteran’s thoracolumbar spine disorder is rated 40 percent disabling since July 18, 2018. After a review of the evidence of record, the Board finds that a higher rating is not warranted. As noted above, and pursuant to the General Rating Formula for Diseases and Injuries of the Spine, the criteria for a rating in excess of 40 percent require unfavorable ankylosis. The Board acknowledges that a July 2018 DBQ shows unfavorable ankylosis of the entire spine (cervical and thoracolumbar), and that the Veteran and his representative have argued that an increased 100 percent rating is warranted on this basis. However, the July 2018 DBQ also shows forward flexion of the thoracolumbar spine of 30 degrees, extension of 5 degrees, right lateral flexion of 15 degrees, left lateral flexion of 10 degrees, right lateral rotation of 15 degrees, and left lateral rotation of 15 degrees. These range of motion findings are inconsistent with a finding of unfavorable ankylosis of the thoracolumbar spine or the entire spine. Further, contrary to the July 2018 DBQ, the March 2020 DBQ specifically notes that there is no ankylosis. The March 2020 DBQ shows forward flexion of 25 degrees, and 20 degrees after repeated use over time. The VA treatment records also show no evidence of ankylosis. See VA treatment records through May 2020. Given the inconsistent nature of the findings in the July 2018 DBQ, the contrary findings on later physical examination, the Board declines to award an increased 100 percent rating based on unfavorable ankylosis. The Board notes that the Veteran reported flareups in July 2018. See July 2018 DBQ. The Board has considered Correia v. McDonald, 28 Vet. App. 158 (2016) and the Court’s holding in Sharp v. Shulkin, 29 Vet. App. 26 (2017) which requires examiners to characterize additional functional loss during flare-ups when the examination is not conducted during a flare-up. However, a 40 percent rating is the maximum schedular rating available for limitation of motion of the thoracolumbar spine under the General Rating Formula, to include the functional equivalent of limitation of motion. Therefore, the Board finds that Correia and Sharp are inapplicable in the instant case, and a retrospective opinion is not needed. For these reasons, the Board finds that a rating in excess of 40 percent is not warranted under the General Rating Formula for Diseases and Injuries of the Spine. Additionally, a higher rating is not warranted under the Formula for Rating IVDS Based on Incapacitating Episodes. The Board acknowledges that the July 2018 DBQ shows IVDS having a total duration of incapacitating episodes of six weeks over the prior twelve months. However, the Board again finds that the July 2018 DBQ is inconsistent with the other evidence of record as the record is otherwise silent for a diagnosis of IVDS and physician-prescribed bedrest during this time period. Significantly, the physician who prepared the July 2018 DBQ cited no clinical evidence demonstrating physician-prescribed bedrest. Further, a March 2020 DBQ specifically notes that the Veteran does not have IVDS of the thoracolumbar spine. The Board finds the March 2020 DBQ more probative than the July 2018 DBQ as the July 2018 DBQ is inconsistent with the other evidence of record, and thus declines to award a higher rating based on IVDS. The Board has considered the revised criteria under DC 5243, effective February 7, 2021. See 85 Fed. Reg. 76453 (February 7, 2021) (codified at 38 C.F.R. § 4.71a). However, there is no relevant evidence dated February 7, 2021 or later in this case, and thus the amended criteria are inapplicable. The Board has also considered associated neurologic abnormalities. The Veteran is currently in receipt of service connection for radiculopathy of the right and left lower extremities associated with his thoracolumbar spine disorder. The Board also finds that a remand is warranted to evaluate the Veteran’s bowel and bladder disturbance throughout the appeal period, as discussed below. Aside from lower extremity radiculopathy and bowel and bladder disturbance, the Board finds that a separate rating is not warranted for any other neurological impairment as associated with the Veteran’s thoracolumbar spine disorder. 3. Throughout the appeal period, a rating of 20 percent for right lower extremity radiculopathy and 20 percent for left lower extremity radiculopathy are granted. Service connection is in effect for radiculopathy of the right and left lower extremities and each is assigned a 10 percent disability rating since September 22, 2005 under DC 8520. Pursuant to 38 C.F.R. § 4.124a, DC 8520, disability ratings of 10, 20, and 40 percent are warranted, respectively, for mild, moderate, and moderately severe incomplete paralysis of the sciatic nerve. A disability rating of 60 percent is warranted for severe incomplete paralysis with marked muscle atrophy. An 80 percent rating is warranted with complete paralysis of the sciatic nerve. The term “incomplete paralysis” with this and other peripheral nerve injuries indicates a degree of lost or impaired function substantially less than the type pictured for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. The ratings for the peripheral nerves are for unilateral involvement; when there is bilateral involvement, the VA adjudicator is to combine the ratings for the peripheral nerves, with application of the bilateral factor. 38 C.F.R. § 4.124a. The Board notes that the Veteran’s treatment records show radiation to the lower extremities and a diagnosis of lumbar radiculopathy. See August 2005 private treatment record; September 2010 VA treatment record; May 2012 private treatment record; February 2014 through December 2014 VA treatment records. An October 2005 private treatment record shows diminished touch and pin-prick sensations in both legs and deep tendon reflex lost at both ankles, with all other TPP sensations generally normal and vibration and position senses preserved. At the October 2010 VA back examination, the Veteran reported a history of numbness and paresthesias in the same distribution as the radiating pain to his lower extremities, unsteadiness, a fall once in the last twelve months, and leg weakness, in the entire legs upper and lower. Upon examination, knee jerk reflexes were absent bilaterally and ankle jerk reflexes were normal bilaterally. The examiner found normal vibration, position sense, pain or pinprick, and light touch, and no dysesthesias. At the June 2014 DBQ, the examiner noted no radiculopathy. The July 2018 DBQ assessed the right lower extremity radiculopathy as severe and left lower extremity radiculopathy as moderate. The examiner noted constant, moderate pain in the bilateral lower extremities; intermittent pain that was severe in the right lower extremity and moderate in the left lower extremity; dull pain that was severe in the right lower extremity and moderate in the left lower extremity; paresthesias and/or dysthesias that were severe in the right lower extremity and moderate in the left lower extremity; and numbness that was severe in the right lower extremity and moderate in the left lower extremity. The straight leg raising test was positive bilaterally. Sensory examination showed sensation to light touch decreased bilaterally in the upper anterior thigh (L2), decreased bilaterally in the thigh/knee (L3/4); normal in the lower leg/ ankle, and normal in the feet and toes. Additionally, position sense was normal bilaterally; vibration sense was decreased in the right and normal in the left extremity; and cold sensation was normal. The reflex examination demonstrated normal reflexes in the knee and ankle. The examiner noted muscle atrophy in the glutes and thighs bilaterally. Muscle strength testing measured 4/5 on all testing performed on the bilateral lower extremities. By comparison, the March 2020 back DBQ showed that the Veteran reported pain radiating into the back of his legs all the way to his toes, more on the right, with tingling and numbness in the feet. However, upon examination, the examiner determined there was no radiculopathy based on normal straight leg raising test results. In light of the aforementioned evidence, the Board finds that an increased rating of 20 percent for radiculopathy of each lower extremity is warranted throughout the entire appeal period. The Board has determined that a rating in excess of 20 percent is not warranted for either lower extremity radiculopathy as the findings noted above do not show that the Veteran’s radiculopathy is moderately severe. Further, although there is some muscle atrophy noted in July 2018, the evidence does not show marked muscle atrophy and there is no evidence of complete paralysis of the sciatic nerve. 4. Entitlement to a TDIU is granted effective July 18, 2018. The Veteran has been awarded TDIU effective September 4, 2018. The Board finds that an earlier effective date of July 18, 2018 is warranted for the Veteran’s award of a TDIU. When evidence of unemployability is submitted during the appeal from an assigned disability rating, a claim for TDIU benefits will be considered part of the claim for benefits for the underlying disability. See Rice v. Shinseki, 22 Vet. App. 447 (2009). As the Veteran contended that his thoracolumbar spine condition prevented him from maintaining employment, TDIU is considered part of the Veteran’s claim for an increased rating for his thoracolumbar spine condition. See September 2018 VA Form 21-8940, Application for Increased Compensation Based on Unemployability. To qualify for a total rating for compensation purposes, the evidence must show: (1) a single disability rated as 100 percent disabling; or (2) that the veteran is unable to secure or follow a substantially gainful occupation as a result of his service-connected disabilities and there is one disability ratable at 60 percent or more, or, if more than one disability, at least one disability ratable at 40 percent or more and a combined disability rating of 70 percent. 38 C.F.R. § 4.16(a). For the purpose of establishing one 60 percent disability, or one 40 percent disability in combination, disabilities affecting a single body system are considered as one disability. Id. Disabilities that are not service connected cannot serve as a basis for a total disability rating. 38 C.F.R. §§ 3.341, 4.19. Unlike the regular disability rating schedule, which is based on the average work-related impairment caused by a disability, “entitlement to a TDIU is based on an individual’s particular circumstances.” Rice v. Shinseki, 22 Vet. App. 447, 452 (2009). Therefore, in adjudicating a TDIU claim, VA must take into account the individual Veteran’s education, training, and work history. Hatlestad v. Derwinski, 1 Vet. App. 164 (1991) (level of education is a factor in deciding employability); see Friscia v. Brown, 7 Vet. App. 294 (1994) (considering Veteran’s experience as a pilot, his training in business administration and computer programming, and his history of obtaining and losing 19 jobs in the previous 18 years); Beaty v. Brown, 6 Vet. App. 532 (1994) (considering Veteran’s 8th grade education and sole occupation as a farmer); Moore v. Derwinski, 1 Vet. App. 356 (1991) (considering Veteran’s master’s degree in education and his part-time work as a tutor). The United States Court of Appeals for the Federal Circuit (Federal Circuit) held that determination of whether a Veteran is unable to secure or follow a substantially gainful occupation due to service-connected disabilities is a factual rather than a medical question and that it is an adjudicative determination properly made by the Board or the RO. See Geib v. Shinseki, 733 F.3d 1350 (Fed. Cir. 2013). The Veteran meets the threshold schedular requirement for an award of TDIU benefits under 38 C.F.R. § 4.16(a) due to his service-connected disabilities effective July 18, 2018. Pursuant to this Board decision, from July 18, 2018, the Veteran is in receipt of a 40 percent rating for a thoracolumbar spine disorder, a 20 percent rating for radiculopathy of the right lower extremity associated with a thoracolumbar spine disorder, and a 20 percent rating for radiculopathy of the left lower extremity associated with a thoracolumbar spine disorder. As these disabilities result from a common etiology, this is considered one disability ratable at 60 percent. Accordingly, the Veteran meets the schedule requirements for TDIU effective July 18, 2018. The evidence shows that the Veteran’s service-connected thoracolumbar spine disorder and associated lower extremity conditions prevent him from securing or following substantially gainful employment. The Veteran notes that he last worked in June 2005, and that he last applied to work in January 2008. See September 2018 VA Form 21-8940, Veteran’s Application for Increased Compensation Based on Unemployability. He stated that he last worked as a motor coach driver, which involved driving long hours across the country, loading bags, helping passengers on and off the coach, concentration for hours at a time, and personal service relations. He contended that he became increasingly unable to perform these job duties without increasing pain and that taking the required medication caused him not to be able to do his job as it made it dangerous. Id. In a June 2019 VA Form 21-8940, the Veteran reported that he last worked in July 1999; and that he had to leave after pain and function in his legs increased and it became dangerous to safely operate vehicles. In a July 2018 DBQ, the examiner noted that the Veteran’s back condition impacted his ability to perform any type of occupation and impacting his ability to drive, stand, walk, exercise, lift, conduct computer work, and maintain childcare. He noted that these activities increased pain and decreased his ability to perform activities of daily living. In light of the Veteran’s contentions and the foregoing evidence in support of his claim, and resolving doubt in the Veteran’s favor as mandated by law (38 U.S.C. § 5107; 38 C.F.R. § 3.102), the Board finds that the Veteran’s service-connected conditions prevent him from securing or following substantially gainful employment since July 18, 2018. Accordingly, entitlement to a TDIU is warranted effective July 18, 2018. Prior to July 18, 2018, the Veteran’s service-connected disabilities were as follows: 1) thoracolumbar spine disorder, rated 20 percent disabling; 2) radiculopathy of the right lower extremity, rated 20 percent disabling; and 3) radiculopathy of the left lower extremity, rated 20 percent disabling. The Veteran’s combined schedular rating was 50 percent from September 22, 2005 to July 17, 2018. Accordingly, prior to July 18, 2018, the schedular requirements for an award of TDIU were not met. REASONS FOR REMAND 1. Entitlement to a compensable rating for a bladder condition associated with the Veteran’s thoracolumbar spine disorder is remanded. In evaluating the Veteran’s thoracolumbar spine disability, the Board must consider other objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, separately, that are associated with the Veteran’s thoracolumbar spine disability pursuant to Note (1) following 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine. An August 2005 private treatment record shows an impression of lumbar radiculopathy with complaints of bowel and bladder disturbance in August 2005. The July 2018 DBQ shows that associated objective neurologic abnormalities include increasing urgency with episodes of incontinence. A VA examination is warranted to evaluate the severity of the Veteran’s bowel and bladder conditions as associated with his thoracolumbar spine disorder throughout the appeal period. 2. Prior to July 18, 2018, entitlement to TDIU on an extraschedular basis is remanded. Although TDIU is not warranted on a schedular basis prior to July 18, 2018, TDIU may still be assigned on an extraschedular basis under 38 C.F.R. § 4.16(b). Where this is warranted, the claim must first be referred by the AOJ to the Director, Compensation Service for extraschedular consideration. The issue of entitlement to TDIU on an extraschedular basis prior to July 18, 2018 must be remanded for referral to the Director, Compensation Service for extraschedular consideration. The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination to ascertain the severity and manifestations of the Veteran’s bowel and bladder disturbance due to service-connected thoracolumbar spine disorder. The examiner must address the current severity of these conditions and provide a retrospective medical opinion regarding the severity and manifestations of these conditions since September 22, 2005. The claims file should be made available to the examiner for review in connection with the examination. 2. Refer the issue of entitlement to TDIU prior to July 18, 2018 to the Director, Compensation Service for extraschedular consideration. S.C. Krembs Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Samuelson, Cheryl 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.