Citation Nr: 21015200 Decision Date: 03/16/21 Archive Date: 03/16/21 DOCKET NO. 13-06 246 DATE: March 16, 2021 ORDER Prior to December 14, 2011, entitlement to an initial disability rating in excess of 10 percent for a back disability is denied. Beginning December 14, 2011, entitlement to an increased disability rating of 40 percent, but no higher, for a back disability is granted. Entitlement to a separate rating of 10 percent, but no higher, for right lower extremity radiculopathy of the sciatic nerve from November 19, 2010 to October 17, 2019 is granted. Entitlement to a separate rating of 10 percent, but no higher, for left lower extremity radiculopathy of the sciatic nerve from November 19, 2010 to October 17, 2019 is granted. Beginning October 18, 2019, a rating in excess of 20 percent for right lower extremity radiculopathy of the sciatic nerve is denied. Beginning October 18, 2019, a rating in excess of 20 percent for left lower extremity radiculopathy of the sciatic nerve is denied. Beginning October 18, 2019, a rating in excess of 20 percent for right lower extremity radiculopathy of the femoral nerve is denied. Entitlement to a rating in excess of 20 percent for neurogenic bladder is denied. REMANDED Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. FINDINGS OF FACT 1. Prior to December 14, 2011, the Veteran’s back disability was not manifested by ankylosis, whether favorable or unfavorable, of the entire spine or thoracolumbar spine, forward flexion of the thoracolumbar spine to 60 degrees or less, combined range of motion of the thoracolumbar spine less than 120 degrees, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour, or additional functional loss. 2. Beginning December 14, 2011, the Veteran’s back disability is manifested by additional functional loss more closely approximating forward flexion to less than 30 degrees. It is not manifested by unfavorable ankylosis of the thoracolumbar spine or entire spine. 3. From November 19, 2010 to October 17, 2019, the Veteran’s right lower extremity radiculopathy of the sciatic nerve was manifested by mild, incomplete paralysis. It was not manifested by at least moderate, incomplete paralysis or complete paralysis. 4. From November 19, 2010 to October 17, 2019, the Veteran’s left lower extremity radiculopathy of the sciatic nerve was manifested by mild, incomplete paralysis. It was not manifested by at least moderate, incomplete paralysis or complete paralysis. 5. Beginning October 18, 2019, the Veteran’s right lower extremity radiculopathy of the sciatic nerve was manifested by no more than moderate, incomplete paralysis. 6. Beginning October 18, 2019, the Veteran’s left lower extremity radiculopathy of the sciatic nerve was manifested by no more than moderate, incomplete paralysis. 7. Beginning October 18, 2019, the Veteran’s right lower extremity radiculopathy of the femoral nerve was manifested by no more than moderate, incomplete paralysis. 8. The Veteran’s urinary incontinence requires absorbent material which must be changed less than 2 times per day, but does not require absorbent material which must be changed two to four times per day. CONCLUSIONS OF LAW 1. Prior to December 14, 2011, the criteria for an initial disability rating in excess of 10 percent for a back disability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5242-5243. 2. Beginning December 14, 2011, the criteria for an increased rating of 40 percent, but no higher, for a back disability have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5242-5243. 3. The criteria for a separate rating of 10 percent, but no higher, for right lower extremity radiculopathy of the sciatic nerve from November 19, 2010 to October 17, 2019, have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.3, 4.7, 4.124a, Diagnostic Code 8720. 4. The criteria for a separate rating of 10 percent, but no higher, for left lower extremity radiculopathy of the sciatic nerve from November 19, 2010 to October 17, 2019, have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.3, 4.7, 4.124a, Diagnostic Code 8720. 5. Beginning October 18, 2019, the criteria for entitlement to a rating in excess of 20 percent for right lower extremity radiculopathy of the sciatic nerve have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 3.102, 4.1, 4.7, 4.40, 4.45, 4.71a, 4.124a, Diagnostic Code 8720. 6. Beginning October 18, 2019, the criteria for entitlement to a rating in excess of 20 percent for left lower extremity radiculopathy of the sciatic nerve have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 3.102, 4.1, 4.7, 4.40, 4.45, 4.71a, 4.124a, Diagnostic Code 8720. 7. Beginning October 18, 2019, the criteria for entitlement to a rating in excess of 20 percent for right lower extremity radiculopathy of the femoral nerve have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 3.102, 4.1, 4.7, 4.40, 4.45, 4.71a, 4.124a, Diagnostic Code 8726. 8. The criteria for entitlement to a rating in excess of 20 percent for neurogenic bladder have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.21, 4.115a, 4.115b, Diagnostic Code 7542. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from February 1980 to July 1990. In November 2017 decision, the Board denied the Veteran’s claims of entitlement to an increased rating for his back disability and TDIU. The Veteran appealed the Board’s decision to the United States Court of Appeals for Veterans Claims (hereafter Court). In an August 2018 Order, the Court vacated the Board’s decision with regard to these issues pursuant to a Joint Motion for Remand (JMR). Subsequently, the Board remanded the issues in an October 2018 decision. The claims are back before the Board for further appellate proceedings. The Board finds there has been substantial compliance with its remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Increased Rating Disability ratings are determined by applying a schedule of ratings that is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R., Part 4. Each disability must be viewed in relation to its history and the limitation of activity imposed by the disabling condition should be emphasized. 38 C.F.R. § 4.1. Where the question for consideration is the propriety of the initial evaluation assigned, consideration of the medical evidence since the effective date of the award of service connection is required. See Fenderson v. West, 12 Vet. App. 199, 125-26 (1999). Where entitlement to compensation already has been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). The Board will consider whether separate ratings may be assigned for separate periods of time based on facts found, a practice known as “staged ratings,” whether it is an initial rating case or not. See Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007). 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. 38 C.F.R. § 4.7. Importantly, the evaluation of the same disability under various diagnoses is to be avoided. 38 C.F.R. § 4.14. However, when it is not possible to separate the effects of the service-connected disability from a nonservice-connected condition, such signs and symptoms must be attributed to the service-connected disability. Mittleider v. West, 11 Vet. App. 181, 182 (1998); 38 C.F.R. § 3.102. 1. Back Disability Here, the Veteran claims that his back disability is more severe than his initial disability rating would indicate. See July 2020 Veteran statement. He was granted service connection from January 18, 2007. Currently, the Veteran’s back disability is rated as 10 percent disabling from January 18, 2007, 20 percent disabling from February 19, 2016, and 40 percent disabling from October 18, 2019. Under 38 C.F.R. § 4.71a, all spinal disabilities are evaluated under the General Rating Formula for Diseases and Injuries of the Spine. If the Veteran has Intervertebral Disc Syndrome (IVDS), the Veteran may also be evaluated under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes. Ultimately, the Veteran’s disability rating will depend on which diagnostic code results in the higher evaluation. Here, though the Veteran had IVDS, he did not require bed rest from a physician. See, e.g., October 2007, December 2011, February 2016, April 2017, and October 2019 VA examination reports. Bed rest prescribed by a physician is a prerequisite to obtain a higher rating under Diagnostic Code 5243; as the Veteran did not have any bed rest prescribed by a physician, the Veteran’s back disability shall be more favorably rated under the General Rating Formula for Diseases and Injuries of the Spine. The pertinent criteria under the General Rating Formula for Diseases and Injuries of the Spine are as follows: Unfavorable ankylosis of the entire spine - 100 percent disabling. Unfavorable ankylosis of the entire thoracolumbar spine - 50 percent disabling. Forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine - 40 percent disabling. Forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis - 20 percent disabling. 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 normal combined range of motion of the thoracolumbar spine is 240 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 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. 38 C.F.R. § 4.71a, Diagnostic Codes 5235 to 5242, Note (2). A. Period prior to December 14, 2011 The Veteran attended a VA examination in October 2007. The Veteran reported back pain at a level of 7/10 daily. The examiner noted forward flexion was previously limited to 75 degrees during a 1997 examination but did not record any current measurements for range of motion testing. The Veteran reported back pain associated with repetitive bending and lifting more than 30 pounds. He stated that he modifies his daily activities as to not impact his spine. The Veteran reported that after four hours of working he experiences symptoms associated with his back, and that he uses lumbar support in his chair along with stretches to help alleviate stiffness and pain throughout his day. Further, he noted driving becomes painful after four hours and he must stop to stretch. He also reported muscle spasms in his right side that radiate to both sides on the flank area. See October 2007 VA examination report. A December 2007 addendum note was added to the examination report and stated that the Veteran has not had an incapacitating episode of low back pain within the last 12 months. It noted that the Veteran had flare ups daily associated with walking a half mile, bending, lifting, or working over 4 hours. See December 2007 addendum note. Ultimately, for the period prior to December 14, 2011, the Board finds that a rating in excess of 10 percent is not warranted. The evidence of record, to include the Veteran’s VA treatment records and the October 2007 VA examination, shows that at no point during this period had the Veteran experienced limitation of forward flexion to 60 degrees or less; or spasms or guarding resulting in abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis; or any ankylosis. The Veteran reported muscle spasms. However, the evidence does not show that those spasms ever resulted in abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. The Board acknowledges the Veteran’s reports of pain or stiffness, but there is no evidence that these symptoms correspond to a rating in excess of 10 percent for this period on appeal. Specifically, the Veteran does not describe any type of limitation of motion when reporting his pain and stiffness, specifically nothing of record indicates that his forward flexion was limited to 60 degrees or less during this period on appeal. The Board has also considered whether higher ratings are warranted based on functional loss due to pain, weakness, fatigability, or incoordination. See DeLuca v. Brown, 8 Vet. App. 202, 204-07 (1995); see also 38 C.F.R. §§ 4.40, 4.45, 4.59 (2017). Although the evidence does show that the Veteran may experience painful motion and fatigability, it does not result in a higher rating unless it results in additional functional loss. See Mitchell v. Shinseki, 25 Vet. App. 32, 42-43 (2011). The Board finds the preponderance of the evidence of record more closely approximates the criteria for a 10 percent rating. Accordingly, entitlement to an initial disability rating greater than 10 percent for a back disability, for the period prior to December 14, 2011, is denied. B. Period beginning December 14, 2011 The Veteran attended a VA examination in December 2011. In relevant part, the Veteran reported that his daily pain level was a 7-8, and that during flares it increases to a 9—making him immobile, or unable to move. See December 2011 VA examination report. He reported that during these flares, he cannot move and must “just be sitting or laying [sic].” Id. However, no estimate of additional loss of range of motion during a flare-up was recorded by the examiner. The Veteran attended a February 2016 VA examination. He again reported flare-ups and stated that his back pain is increased with walking or doing household chores causing his back to get stiff. See February 2016 VA examination report. However, the examiner did not describe this additional loss in terms of range of motion because they were “not examining during a flare.” Id. The Veteran attended a VA examination in April 2017. The Veteran reported flare-ups, but the examiner again did not provide any estimate in terms of range of motion, stating that they “cannot report the extent of limitation of motion during a flare-up because I have not examined the veteran under those conditions.” See April 2017 VA examination report. Most recently, the Veteran attended a VA examination in October 2019. Finally, when the Veteran reported flare-ups, the examiner was able to provide the required estimate in terms of range of motion. During a flare-up, the Veteran’s range of motion was estimated to be from 0 to 0 degrees for forward flexion. See October 2019 VA examination report. Notably, the Veteran first reported similar limitations regarding functional loss during a flare-up at his December 2011 VA examination when he said flares caused him to be “immobile.” See December 2011 VA examination report. The Board finds that this report of not being able to move/immobility to be the first evidence of the severe restriction of movement the Veteran experiences during his flares. Thus, affording the Veteran the benefit of the doubt, the Board finds that the evidence supports that the Veteran’s back disability more closely approximates the criteria for a 40 percent rating beginning the date of his December 2011 VA examination—which was conducted on December 14, 2011. It is at this point, but no earlier, that the Veteran’s flare-ups can be determined to limit his forward flexion to 30 degrees or less. Therefore, a 40 percent rating based on forward flexion to 30 degrees or less is warranted beginning December 14, 2011. Nevertheless, the Veteran is not entitled to a 50 percent disability rating because his symptoms do not more closely approximate unfavorable ankylosis of the spine. Again, the Board has considered whether higher ratings are warranted based on functional loss due to pain, weakness, fatigability, or incoordination. See DeLuca v. Brown, 8 Vet. App. 202, 204-07 (1995); see also 38 C.F.R. §§ 4.40, 4.45, 4.59. Although the evidence does show that the Veteran may experience painful motion, it does not result in a higher rating unless it results in additional functional loss. See Mitchell v. Shinseki, 25 Vet. App. 32, 42-43 (2011). Here, after considering additional functional loss based on pain, fatigue, weakness, and lack of endurance, the October 2019 VA examiner determined the Veteran’s forward flexion would be to 0 degrees during flare-ups. See October 2020 VA examination report. However, the VA examiner did not find the Veteran’s additional functional loss amounted to unfavorable ankylosis. Specifically, unfavorable ankylosis is defined as a condition where the entire thoracolumbar spine is fixed in flexion or extension, and the ankylosis results in one or more the following : (1) difficulty walking because of a limited line of vision; (2) restricted opening of the mouth and chewing; (3) breathing limited to diaphragmatic respiration; (4) gastrointestinal symptoms due to pressure of the costal margin on the abdomen; (5) dyspnea or dysphagia; (6) atlantoaxial or cervical subluxation or dislocation; or (7) neurologic symptoms due to nerve root stretching. Importantly, fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis (as is the case here). See 38 C.F.R. § 4.71A, Diagnostic Code 5237, Note (5). Here, even considering additional functional loss, the Veteran’s fixation would be in a neutral position, which always represents favorable ankylosis. Further, none of the other factors apply in the Veteran’s case because his back is not fixed in either flexion or extension per the October 2019 VA examination. Therefore, neither 50 nor 100 percent disability ratings are warranted under the General Formula. Therefore, an increased rating of 40 percent, but no higher, is granted beginning December 14, 2011. 2. Bilateral Lower Extremity Radiculopathy Pursuant to Note (1) of the General Rating Formula for Diseases and Injuries of the Spine, VA is to evaluate any associated objective neurologic abnormalities separately under an appropriate diagnostic code. See 38 C.F.R. § 4.71a, Diagnostic Code 5237, Note (1). Neuritis of the peripheral nerves, characterized by loss of reflexes, muscle atrophy, sensory disturbances, and constant pain, at times excruciating, is to be rated on the scale provided for injury of the nerve involved, with a maximum rating equal to severe, incomplete, paralysis. The maximum rating that may be assigned for neuritis not characterized by organic changes referred to in this section will be that for moderate, or with sciatic nerve involvement, for moderately severe, incomplete paralysis. 38 C.F.R. § 4.123. Neuralgia of a peripheral nerve characterized usually by a dull and intermittent pain, of typical distribution so as to identify the nerve, is to be rated on the same scale, with a maximum equal to moderate incomplete paralysis. The term incomplete paralysis, with peripheral nerve injuries, indicates a degree of lost or impaired function substantially less than the type picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. The ratings for the peripheral nerves are for unilateral involvement; when bilateral, combine with application of the bilateral factor. 38 C.F.R. § 4.124. In a June 2020 rating decision, the Veteran was service connected for radiculopathy affecting his bilateral lower extremities. Specifically, his bilateral sciatic nerves (evaluated under Diagnostic Code 8720), and his right femoral nerve (evaluated under Diagnostic Code 8762). See June 2020 rating decision. All of which were granted with an evaluation of 20 percent disabling effective October 18, 2019. Diagnostic Code 8720 provides ratings for neuralgia of the sciatic nerve, and is rated under Diagnostic Code 8520. Under Diagnostic Code 8520, a 20 percent rating is warranted for moderate incomplete paralysis of the sciatic nerve. A 40 percent rating is warranted when there is moderately-severe incomplete paralysis. A 60 percent rating is warranted when there is severe incomplete paralysis, with marked muscular atrophy. Complete paralysis of the sciatic nerve warrants an 80 percent rating. When there is complete paralysis of the sciatic nerve, the foot dangles and drops, there is no active movement possible of muscle below the knee, and flexion of the knee is weakened or (very rarely) lost. 38 C.F.R. § 4.124a. Diagnostic Code 8726 provides ratings for the femoral nerve. Under Diagnostic Code 8726, a 20 percent rating is warranted for moderate incomplete paralysis of the femoral nerve. A 30 percent rating is warranted when there is severe incomplete paralysis. A 40 percent rating is warranted when there is complete paralysis of quadriceps extensor muscles. 38 C.F.R. § 4.124a. A. Period beginning November 19, 2010 The Board finds that the Veteran showed signs and symptoms associated with his service-connected radiculopathy as early as November 19, 2010. Specifically, the Veteran reported lower back and leg pain that radiates to the back of his thighs. See November 2010 VA treatment note. This is the first report of record wherein the Veteran notes pain associated with his back that travels, or radiates, to his legs. He was subsequently given a physical therapy referral for back pain with possible radiculopathy. See December 2010 VA treatment note; see also January 2011 VA treatment note. At his December 2011 VA examination, the examiner noted that the Veteran had mild intermittent pain (usually dull) in his bilateral lower extremities. He had a positive straight leg test on the right side. Ultimately, the examiner found that the Veteran had mild radicular pain involving the sciatic nerve on his right side. See December 2011 VA examination. The Board notes that the December 2011 VA examiner only identified right side radiculopathy involving the sciatic nerve upon examination. However, affording the Veteran the benefit of the doubt, the Board finds it is reasonable to believe both his right and left side sciatic radiculopathy was present at the time given that he complained of pain in both of his thighs as early as November 2010. See November 2010 VA treatment note. Further, the Board notes that the February 2016 and April 2017 VA examiners did not find any signs or symptoms of radiculopathy associated with the Veteran’s back disability. See February 2016 VA examination; see also April 2017 VA examination. However, the Board reconciles this considering the mild severity of his symptoms associated with the radiculopathy at the time; it was likely that they were present but not severe enough to be documented by these examiners. Moreover, the Veteran reported “numbness down his legs” in May 2013, and “radiating numbness” associated with his back pain in December 2015. See May 2013 VA treatment note; see also December 2015 VA treatment note. The Board finds that a date prior to November 19, 2010 is not warranted as the Veteran did not show any signs or symptoms associated with radiculopathy before then. Prior to that date, the Board does not have an evidentiary anchor with which to assign a rating. Notably, the Veteran denied any numbness and tingling in his legs in May 2007. See May 2007 VA treatment note. Moreover, the October 2007 VA examination made no mention of symptoms akin to that of radiculopathy. See October 2007 VA examination report. For this period the Board finds that the Veteran’s symptoms demonstrated no more than mild incomplete paralysis. An evaluation in excess of 10 percent requires evidence of moderate incomplete paralysis. Such is not shown in this case, particularly given the negative findings at both the February 2016 and April 2017 VA examinations. Therefore, the Board finds that a separate rating of 10 percent, but no higher, for both his right and left lower extremity radiculopathy of the sciatic nerve is granted from November 19, 2010 to October 17, 2019. B. Period beginning October 18, 2019 Upon examination in October 2019, the examiner indicated that the overall severity of both the Veteran’s right and left lower extremity radiculopathy was moderate. See October 2019 VA examination report. There was no evidence of muscle atrophy. The Veteran had no constant pain, but severe intermittent pain (usually dull), severe paresthesias and/or dysesthesias, and severe numbness of his bilateral lower extremities. Id. Upon careful review of the record, the Board has concluded that, beginning October 18, 2019, an evaluation in excess of 20 percent for the Veteran’s bilateral lower extremity radiculopathy is not warranted. In that regard, the evidence of record demonstrates no more than moderate incomplete paralysis associated with the Veteran’s lower extremity radiculopathy. An evaluation in excess of 20 percent requires evidence of moderately severe incomplete paralysis. Such is not shown in this case. Rather, the evidence addressing the severity of the Veteran’s radiculopathy consists of the October 2019 VA examination report, which indicates that it is no more than moderate. The Board acknowledges that the “severe” boxes were checked for various symptoms associated with the Veteran’s radiculopathy. However, the Board affords more probative weight to the overall severity of moderate level assigned by the examiner, which was assigned in conjunction with a review of all of the evidence, taking into account the Veteran’s reports of symptoms and severity, and in in person examination. See October 2019 VA examination report. Importantly strength testing in the lower extremities was either 3/5 or 4/5 and sensory testing was decreased, but not absent. The Board notes that this is the first indication in the record that there is involvement of the Veteran’s femoral nerve as well. See October 2019 VA examination report. Thus, no earlier date for a separate evaluation pursuant to Diagnostic Code 8726 will be awarded than already is. The Board notes that the Veteran is competent to report the severity of his lower extremity radiculopathy; however, the Veteran does not contend that his associated lower extremity radiculopathies are more severe than currently rated. Further, the most probative evidence consists of that prepared by neutral skilled professionals, and such evidence demonstrates that the evaluations discussed herein are appropriate. Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). 3. Neurogenic Bladder In a June 2020 rating decision, the AOJ granted service connection for neurogenic bladder as related to his service-connected back disability. The AOJ evaluated this disorder as 20 percent disabling pursuant to 38 C.F.R. § 4.115b, Diagnostic Code 7542. A neurogenic bladder disability must be rated according to the level of voiding dysfunction. See 38 C.F.R. § 4.115b, Diagnostic Code 7542. Voiding dysfunction is to be rated as urine leakage, frequency, or obstructed voiding. 38 C.F.R. § 4.115a. As this is considered an associated objective neurologic abnormality related to the Veteran’s claim for an increased rating for his service-connected back, it shall also be discussed in the instant decision. A 20 percent rating is assigned when the wearing of absorbent materials is required and when the absorbent materials must be changed less than two times per day. Urinary incontinence or leakage requiring the wearing of absorbent materials that must be changed two to four times per day is assigned a 40 percent rating. Urinary incontinence or leakage requiring the use of an appliance or the wearing of absorbent materials that must be changed more than four times per day is assigned a 60 percent rating. 38 C.F.R. § 4.115a. The 60 percent is the highest disability rating allowed for voiding dysfunction under Diagnostic Code 7542. The October 2019 VA examination report indicated that the Veteran has a diagnosis of neurogenic bladder, noting the date of diagnosis was 2019. The examiner found that the Veteran requires absorbent material which must be changed less than two times per day. See October 2019 VA examination. The Veteran reported that he leaks urine when his back spasms increase. Id. The Veteran has not indicated that he requires any more frequent changing of absorbent materials than indicated by the VA examiner. Nor does the evidence reflect anything to the contrary. Notably, the Veteran reported no new bowel or bladder symptoms in a November 2020 treatment note. See November 2020 VA treatment note. As such, the Board finds that the Veteran is appropriately rated, and a higher evaluation is not warranted. REASONS FOR REMAND 1. TDIU TDIU presupposes a Veteran is not capable of gainful employment. 38 C.F.R. § 4.16(a). The Veteran’s TDIU application reports his date of last employment was in 2003. See July 2020 VA Form 21-8940. However, the Board notes that the Veteran reported he was working as a self-employed tax consultant during his October 2007 VA examination. See October 2007 VA examination report. Thus, the Board finds that the Veteran’s July 2020 TDIU application was not complete and did not include his self-employment history—which would be necessary in order to properly adjudicate the issue of TDIU. The Board needs clarification regarding the Veteran’s full employment history in light of his previous report of self-employment. In short, it is not entirely clear when in the appeal period the Veteran was working and when he was not. As such, remand is necessary to obtain an employment history covering the entirety of the appeal period, to include any periods of self-employment. The matters are REMANDED for the following action: 1. Obtain any relevant updated outstanding VA and/or private treatment records and associate the same with the claims file. 2. Obtain from the Veteran his full employment history throughout the appeal period, including the dates of any self-employment, and the wages earned during each period of employment and the number of hours worked. 3. In addition to #1-2 above, conduct all other necessary development. 4. After all of the above development is completed, readjudicate the TDIU claim. If the benefit sought is not granted, the Veteran and his representative should be furnished a supplemental statement of the case (SSOC) and afforded a reasonable opportunity to respond before the record is returned to the Board for further review. DONNIE R. HACHEY Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Katie Poe, Associate 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.