Citation Nr: 21023280 Decision Date: 04/20/21 Archive Date: 04/20/21 DOCKET NO. 11-12 120 DATE: April 20, 2021 ORDER Entitlement to a rating in excess of 50 percent for post-traumatic headaches, to include on an extraschedular basis, is denied. Entitlement to a rating in excess of 20 percent for lumbosacral strain, to include on an extraschedular basis, is denied. Entitlement to a rating in excess of 20 percent for cervical strain, to include on an extraschedular basis, is denied. Entitlement to a total disability rating based on individual unemployability (TDIU) from August 31, 2009, to January 10, 2010, is denied. REMANDED The claim of entitlement to a separate 10 percent rating for right lower extremity sciatica prior to November 24, 2018, is remanded. The claim of entitlement to a separate 10 percent rating for left lower extremity sciatica prior to November 24, 2018, is remanded. The claim of entitlement to a separate 20 percent rating for right upper extremity radiculopathy prior to November 24, 2018, is remanded. The claim of entitlement to a separate 20 percent rating for left upper extremity radiculopathy prior to November 24, 2018, is remanded. FINDINGS OF FACT 1. The Veteran is in receipt of the maximum schedular rating for headaches. 2. The 50 percent schedular rating assigned the Veteran’s headache disability contemplates the level of disability and symptomatology of the headaches, rendering the application of the rating schedule adequate. 3. The Veteran’s lumbar spine disability manifests as functionally limiting radiating pain, numbness in the legs, fatigue, stiffness, spasm and painful, decreased motion, worse during flare-ups and on repetitive use, but not forward flexion of the thoracolumbar spine limited to 30 degrees or less or ankylosis. 4. The 20 percent schedular rating assigned for the Veteran’s lumbar spine disability contemplates the level and symptomatology of that disability, rendering the application of the rating schedule adequate. 5. The Veteran’s cervical spine disability manifests as functionally limiting radiating pain, stiffness, spasm and painful, decreased motion, worse during flare-ups and on repetitive use, but not forward flexion of the cervical spine limited to 15 degrees or less or ankylosis. 6. The 20 percent schedular rating assigned the Veteran’s cervical spine disability contemplates the level and symptomatology of that disability, rendering the application of the rating schedule adequate. 7. The Veteran was employed in a substantially gainful occupational from August 31, 2009, to January 10, 2010. CONCLUSIONS OF LAW 1. The criteria for entitlement to a rating in excess of 50 percent for post-traumatic headaches, to include on an extraschedular basis, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.1-4.10, 4.124a, Diagnostic Code (DC) 8100. 2. The criteria for entitlement to a rating in excess of 20 percent for lumbosacral strain, to include on an extraschedular basis, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.1-4.10, 4.40, 4.45, 4.59, 4.71a, DC 5237. 3. The criteria for entitlement to a rating in excess of 20 percent for cervical strain, to include on an extraschedular basis, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.1-4.10, 4.40, 4.45, 4.59, 4.71a, DC 5237. 4. The criteria for entitlement to a TDIU from August 31, 2009, to January 10, 2010, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.340, 4.15, 4.16, 4.18. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 1989 to October 1994. Her claims come before the Board of Veterans’ Appeals (Board) on appeal of May and November 2010 Department of Veterans Affairs (VA) rating decisions continuing the 50 percent rating assigned her headaches and the 10 percent ratings assigned her neck and back disabilities and denying a TDIU. In June 2016 and January 2019, the Board remanded these claims to the Agency of Original Jurisdiction (AOJ) for additional development. There has been substantial compliance with the prior remands. All available outstanding treatment records and the requested addendum opinions have been obtained. In an August 2018 Decision Review Officer decision, the AOJ increased the ratings assigned for the Veteran’s neck and back disabilities to 20 percent. In a December 2020 rating decision, the AOJ granted TDIU from January 11, 2010. Increased Ratings The Veteran is seeking increased ratings for her headaches and lumbar spine and cervical spine disabilities on the basis that they are worsening, interfere with her ability to work and have rendered her destitute. Entitlement to a rating in excess of 50 percent for post-traumatic headaches, to include on an extraschedular basis The AOJ has rated the Veteran’s headaches, characterized as migraines and paroxysmal hemicrania, 50 percent disabling pursuant to 38 C.F.R. § 4.124A, DC 8100. The Veteran asserts that these headaches have worsened and are more severe than the 50 percent rating indicates, warranting an increased schedular or extraschedular rating. She claims that these headaches initially extended down one side of her face, including behind her eye, but now extend down both sides, occur weekly, are frequently prostrating and/or constant, last one to two days or more, typically cause throbbing, a burning sensation, photophobia, phonophobia and difficulty concentrating, have required emergency/urgent medical treatment, and necessitate the use of non-prescription and prescription medications. She further asserts that, when her headaches are most severe (four times yearly), she feels like she’ll die. She describes these headaches as painful with a squeezing and pinching sensation down her face. She has submitted written statements from family members indicating that her health has worsened, in part due to severe headache pain. According to the Veteran’s daughter, due to the pain, which hinders the Veteran from exercising, the Veteran has become obese, affecting her ability to perform certain activities of daily living. The preponderance of the evidence is against this claim. A 50 percent schedular rating is the maximum assignable under 38 C.F.R. § 4.124A, DC 8100. However, because the Veteran contends that her headaches developed secondary to a head injury (has reported something fell on her in service, while in a metal store room on a ship), the Board has considered whether it is more advantageous to rate the Veteran's headaches under DC 8045, which governs rating of residuals of a traumatic brain injury (TBI). Based on the facts of record, rating the Veteran’s headaches as a residual of a TBI would be inappropriate. During the course of the appeal, the Veteran occasionally reported that she had had such an injury (in 2009, reported that it occurred when she was 5), and providers noted a questionable history of a TBI (a couple noting “confirmed” in 2015 and 2016), but none of the Veteran’s treatment records, including test results, substantiates that the injury occurred or shows residuals of a TBI. In October 2019, the Board remanded this matter to the AOJ for medical clarification. During a VA TBI and headache examinations, an examiner specifically found no evidence of a head injury and concluded that the Veteran did not have a TBI or any residuals of a TBI. The question is thus whether the Veteran is entitled to an increased rating for her headaches on an extraschedular basis under § 3.321(b)(1). Determining one’s entitlement to such a benefit involves a three-step inquiry. Thun v. Peake, 22 Vet. App. 111, 115-116 (2008); Anderson v. Shinseki, 22 Vet. App. 423, 427 (2009) (clarifying that the Thun steps are necessary elements of an extraschedular rating). If the Board determines that (1) the schedular rating does not contemplate the claimant’s level of disability and symptomatology, and (2) the disability picture exhibits other related factors such as marked interference with employment or frequent periods of hospitalization, then (3) the case must be referred to an authorized official to determine whether, to accord justice, an extraschedular rating is warranted. 38 C.F.R. § 3.321(b)(1). When the Board finds that an extraschedular rating may be warranted based on the above factors, it cannot grant such a rating in the first instance. Anderson, 23 Vet. App. at 428-429. Rather, it must remand the claim to the AOJ for referral to the Director of Compensation Services (Director) for consideration of an extraschedular rating. 38 C.F.R. § 3.321(b)(1); Thun, 22 Vet. App. at 111. Here, the 50 percent schedular rating assigned the Veteran’s headache disability contemplates not only the symptoms of the headaches (migraine type) but also the level of severity of those symptoms (prostrating or non-prostrating), frequency of attacks, and the extent to which the symptoms interfere with the Veteran’s economic adaptability. As such, the rating schedule is adequate to rate the Veteran’s headache disability picture, and an extraschedular rating may not be assigned. The Board acknowledges the Veteran’s contentions, summarized above, and does not doubt that her headaches have progressed and are as severe as she has described, resulting in functional impairment. However, the 50 percent rating assigned those headaches contemplates headaches of such severity. The criteria for entitlement to a rating in excess of 50 percent for post-traumatic headaches, to include on an extraschedular basis, are therefore not met. Entitlement to a rating in excess of 20 percent for lumbosacral strain, to include on an extraschedular basis The AOJ has rated the Veteran’s lumbar spine disability 20 percent disabling. The Veteran asserts that an increased rating is warranted based on worsening, constant back problems, including severe pain radiating down her back and into her legs, as these problems have affected her job performance and limited the types of jobs she can obtain. She contends that her lumbar spine disability also causes numbness in her legs, fatigue, decreased and painful motion, stiffness, difficulty lifting, carrying, standing or sitting for too long, muscle spasms that shoot up and down her body daily, an occasional inability to bend forward or backward and urinary incontinence, and necessitates the use of a TENS unit, injections and medication. The Veteran reports flare-ups of back pain on repetitive use. The Veteran has submitted written statements from family members indicating that her health has worsened, in part due to back aches and discomfort. These individuals assert that, due to these symptoms, the Veteran has difficulty performing certain activities of daily living. The Veteran’s daughter contends that she has helped her mother put on muscle pain relief cream and take her medication and has witnessed her in severe pain and depressed; she asserts that the pain has hindered her mother from exercising, which has caused her to become overweight. The preponderance of the evidence is against this claim. The Veteran’s lumbar spine disability, characterized in medical records as a lumbosacral strain, degenerative joint disease, spondylolisthesis, scoliosis and intervertebral disc degeneration, is rated under DC 5237, pursuant to the General Rating Formula for Diseases and Injuries of the Spine (general rating formula). 38 C.F.R. § 4.71A, DC 5237. While portions of the rating schedule addressing the musculoskeletal system were revised effective February 7, 2021, this diagnostic code was not changed. According to the general rating formula, a 20 percent rating is assignable 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 not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 40 percent rating is assignable for forward flexion of the thoracolumbar spine to 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is assignable for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent rating is assignable for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine. Any associated objective neurological abnormalities, including but not limited to bowel or bladder impairment, are to be evaluated separately under an appropriate DC. Id. at Note 1. Unfavorable ankylosis is defined as “a condition in which the entire cervical spine, 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.” Id. at Note 5. Additionally, fixation of a spinal segment in neutral position (zero degrees) is “always” considered favorable ankylosis. Id. When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and, therefore, not be reflected on range-of-motion testing. The adjudicator must also consider whether the claimant has less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and/or pain on movement. 38 C.F.R. § 4.45; DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Although the background factors listed in § 4.40 and § 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a; a separate or higher rating under § 4.40 or § 4.45 is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) (guidance of § 4.40 intended to be used in understanding nature of disability, after which rating determined based on the § 4.71a criteria). When a lumbar spine disability involves intervertebral disc syndrome under DC 5243, it may be rated under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes (formula for rating IVDS), if more advantageous. 38 C.F.R. § 4.71a, Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes. The formula for rating IVDS provides that a 10 percent rating is assignable for IVDS with incapacitating episodes having a total duration of at least one week but less than 2 weeks during the past 12 months. A 20 percent rating is assignable for IVDS with incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months. A 40 percent rating is assignable for IVDS with incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months. A 60 percent rating is assignable for IVDS with incapacitating episodes having a total duration of at least 6 weeks during the past 12 months. 38 C.F.R. § 4.71a, Formula for Rating IVDS. 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, DC 5243, Note (1). During the pendency of the appeal, the rating criteria for evaluating musculoskeletal disabilities under 38 C.F.R. § 4.71a were amended effective February 7, 2021. 85 Fed. Reg. 230 (Nov 30, 2020). These amendments revised select diagnostic codes “to ensure that this portion of the rating schedule uses current medical terminology and provides detailed and updated criteria for the evaluation of musculoskeletal disabilities.” Id. As of February 7, 2021, under the amended criteria, Diagnostic Code 5243 was revised to reflect that the diagnostic code should be assigned only when there is disc herniation with compression and/or irritation of the adjacent nerve root. The amended criteria further provide that Diagnostic Code 5242, pertaining to degenerative arthritis and degenerative disc disease other than intervertebral disc syndrome, should be assigned for all other disc diagnoses. Considering both the pre- and post-February 7, 2021, Diagnostic Code 5243, the medical and lay evidence of record does not show that a rating under Diagnostic Code 5243 for IVDS is warranted during the period on appeal. In this case, the Veteran’s lumbar spine symptoms, described above, have not limited forward flexion of her thoracolumbar spine to 30 degrees or less, including on repetitive use or during flare-ups, produced ankylosis of the entire thoracolumbar spine, or involved incapacitating episodes of intervertebral disc syndrome, one of which is required to be assigned the next higher rating. During VA examinations conducted in May 2010, September 2010 and October 2017, the Veteran had no ankylosis and forward flexion of the thoracolumbar spine to, at worst, 45 degrees and, at best, 90 degrees, including on repetitive use. According to a VA examiner who provided an opinion in November 2020, during flare-ups, the Veteran experienced an additional loss of 5 degrees of motion from baseline across all planes. Therefore, at worst, during a flare-up of low back symptoms, the Veteran was still able to forward flex to 40 degrees, 10 degrees beyond what is needed for the next higher rating. Treatment records do not show, and the Veteran has not alleged, that her lumbar spine disability further limits her motion. In addition, although the Veteran underwent multiple VA examinations and sought treatment for her lumbar spine disability during the course of the appeal, no VA examiner or treatment provider noted that the Veteran had incapacitating episodes of IVDS, requiring bedrest. The criteria for entitlement to a schedular rating in excess of 20 percent for the Veteran’s lumbar spine disability are therefore not met, whether evaluated under the general rating formula or the formula for rating IVDS. The question then becomes whether an increased rating is assignable on an extraschedular basis. The 20 percent rating assigned the Veteran’s lumbar spine disability contemplates those symptoms that hinder the Veteran’s range of motion, including the joint pain, fatigue, stiffness and spasm, and their severity in terms of degrees of motion loss. The Veteran has also reported pain affecting her muscles and radiating to various parts of her body and other neurologic symptoms, including numbness, which are not contemplated in the 20 percent rating assigned her lumbar spine disability. Rather, the AOJ has separately service connected the Veteran for disabilities manifested by those symptoms, including fibromyalgia, rated 40 percent disabling, right and left upper extremity radiculopathy, each rated 20 percent disabling, and right and left lower extremity sciatica, each rated 10 percent disabling. The Veteran has also reported that she has incontinence and depression secondary to her lumbar spine disability, but in November 2020, a VA examiner reviewed this file and found that medical literature does not support a finding that such a disability causes or aggravates urge incontinence. In addition, depression is not a neurologic abnormality subject to a separate rating under the general rating formula, Note (1). To the extent the Veteran has a mental health disability secondary to her lumbar spine disability, the appropriate action is to file a claim for such disability on a secondary basis. As the 20 percent schedular rating assigned the Veteran’s lumbar spine disability contemplates the symptoms of that disability as well as the level of severity of those symptoms, the rating schedule is adequate to rate the Veteran’s lumbar spine disability picture, and an extraschedular rating may not be assigned. The Board acknowledges the Veteran’s contentions, summarized above, and the lumbar spine symptoms she has reported, all objectively confirmed in the medical records. It does not doubt that her lumbar spine disability is as severe as she has described, resulting in functional impairment. However, the 20 percent rating assigned that disability contemplates its severity. The criteria for entitlement to a rating in excess of 20 percent for that disability, to include on an extraschedular basis, are therefore not met. Entitlement to a rating in excess of 20 percent for cervical strain, to include on an extraschedular basis The AOJ has rated the Veteran’s cervical spine disability 20 percent disabling. The Veteran asserts that an increased rating is warranted based on constant neck problems as these problems have worsened, affected her job performance and limited the types of jobs she can obtain. She contends that her cervical spine disability has been diagnosed as osteoarthritis and degenerative disk disease, causes constant achy neck pain that radiates up to her eyes and down behind her ears and to her back, inhibiting her ability to open her mouth, catch her breath and/or communicate, stiffness, neck spasms in the throat, shoulder, back of neck and chest areas, limited motion, including on repetitive use, and stiffness and necessitates the use of a cervical collar, pillow, heating pad, TENS unit, muscle relaxant cream, medications and hot showers. The Veteran has submitted written statements from family members indicating that her health has worsened, in part due to discomfort throughout her body. These individuals assert that, due to this discomfort, the Veteran has difficulty performing certain activities of daily living. The Veteran’s daughter contends that she has helped her mother put on muscle pain relief cream and take her medication and has witnessed her in severe pain and depressed; she asserts that the pain has hindered her mother from exercising, which has caused her to become overweight. The preponderance of the evidence is against this claim. The Veteran’s cervical spine disability, characterized in medical records as a cervical strain and degenerative joint disease, is rated under DC 5237. 38 C.F.R. § 4.71A, DC 5237. While portions of the rating schedule addressing the musculoskeletal system were revised effective February 7, 2021, this diagnostic code was not changed. According to the general rating formula, a 20 percent rating is assignable for forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees; or, the combined range of motion of the cervical spine not greater than 170 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 30 percent rating is assignable for forward flexion of the cervical spine 15 degrees or less; or, favorable ankylosis of the entire cervical spine. A 40 percent rating is assignable for unfavorable ankylosis of the entire cervical spine. A 100 percent rating is assignable for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine. In this case, the Veteran’s cervical spine symptoms, described above, have not limited forward flexion of her cervical spine to 15 degrees or less, including on repetitive use or during flare-ups, produced favorable ankylosis of the entire cervical spine, or involved incapacitating episodes of intervertebral disc syndrome. During VA examinations conducted in May 2010, September 2010, January 2013, and October 2017, the Veteran had no ankylosis and forward flexion of her cervical spine to, at worst, 30 degrees and, at best, 45 degrees, including on repetitive use. According to a VA examiner who provided an opinion in November 2020, during flare-ups, the Veteran experienced an additional loss of 5 degrees of motion from baseline across all planes. Therefore, at worst, during a flare-up of neck symptoms, the Veteran was still able to forward flex to 25 degrees, 10 degrees beyond what is needed to assign the next higher rating. Treatment records do not show, and the Veteran has not alleged, that her cervical spine disability further limits her motion. In addition, considering both the pre- and post-February 7, 2021, Diagnostic Code 5243 (noted in the prior section), the medical and lay evidence of record does not show that a rating under Diagnostic Code 5243 for IVDS is warranted during the period on appeal. Although the Veteran underwent multiple VA examinations and sought treatment for her cervical spine disability during the course of the appeal, no VA examiner or treatment provider noted that the Veteran had incapacitating episodes of IVDS, requiring bedrest. The criteria for entitlement to a schedular rating in excess of 20 percent for the Veteran’s cervical spine disability are therefore not met, whether evaluated under the general rating formula or the formula for rating IVDS. The question then becomes whether an increased rating is assignable on an extraschedular basis. The 20 percent rating assigned the Veteran’s cervical spine disability contemplates those symptoms that hinder the Veteran’s range of motion, including pain, stiffness and spasm, and their severity in terms of degrees of motion loss. As noted above, the Veteran has also reported pain affecting her muscles and radiating to various parts of her body, which is not contemplated in the 20 percent rating assigned her cervical spine disability. Rather, the AOJ has separately service connected the Veteran for disabilities manifested by those symptoms, including fibromyalgia and right and left upper extremity radiculopathy and right and left lower extremity sciatica. The Veteran has also reported difficulty opening her mouth, catching her breath and/or communicating in association with her neck pain, and these symptoms are not contemplated in the 20 percent rating assigned her cervical spine disability. However, although treatment records confirm such complaints, they do not include a finding attributing the complaints to the Veteran’s cervical spine disability. As the 20 percent schedular rating assigned the Veteran’s cervical spine disability contemplates the symptoms of that disability as well as the level of severity of those symptoms, the rating schedule is adequate to rate the Veteran’s cervical spine disability picture, and an extraschedular rating may not be assigned. The Board acknowledges the Veteran’s contentions, summarized above, and the cervical spine symptoms she has reported, all objectively confirmed in the medical records. It does not doubt that her cervical spine disability is as severe as she has described, resulting in functional impairment. However, the 20 percent rating assigned that disability contemplates its severity. The criteria for entitlement to a rating in excess of 20 percent for that disability, to include on an extraschedular basis, are therefore not met. Entitlement to a TDIU from August 31, 2009 to January 10, 2010 In December 2020, the AOJ granted TDIU from January 11, 2010. The question is whether the Veteran is entitled to a TDIU for the remainder of the appeal period, from August 31, 2009 to January 10, 2010. The preponderance of the evidence is against this claim. A TDIU may be granted when a claimant’s service-connected disabilities are rated less than total, but they prevent him or her from securing or following all gainful employment. 38 C.F.R. § 4.16. If a claimant has only one disability, that disability must be rated 60 percent or more disabling. If he or she has two or more disabilities, one disability must be rated 40 percent or more disabling and there must be sufficient additional disability to bring the combined rating to 70 percent or more. 38 C.F.R. § 4.16(a). In this case, for the time period at issue, the Veteran satisfies the percentage requirements. From August 31, 2009, to January 10, 2010, she was service connected for post-traumatic headaches, rated 50 percent disabling, cervical strain, rated 20 percent disabling, and lumbosacral strain, rated 20 percent disabling, which translated to a combined disability rating of 70 percent. 38 C.F.R. § 4.250. However, these disabilities did not prevent the Veteran from securing or following all gainful employment. According to a June 2010 VA Form 21-8940 (Veteran’s Application For Increased Compensation Based on Unemployability), the Veteran’s September 2010 and December 2012 written statements and a January 2013 VA examination report, during the time period at issue, she was employed full-time, earning $5,000 monthly. She was reportedly terminated in May 2020, following a period of medical leave without pay that commenced on January 11, 2010. The criteria for entitlement to TDIU from August 31, 2009, to January 10, 2010, are therefore not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.340, 4.15, 4.16, 4.18. REASONS FOR REMAND In a November 2019 rating decision, the AOJ granted separate ratings for neurologic conditions associated with the Veteran’s lumbar spine and cervical spine disabilities, including right lower extremity sciatica, rated 10 percent disabling, left lower extremity sciatica, rated 10 percent disabling, right upper extremity radiculopathy, rated 20 percent disabling, and left upper extremity radiculopathy, rated 20 percent disabling, all effective from November 24, 2018. The Veteran asserts that she experienced symptoms of these disabilities as far back as 2010, secondary to her lumbar spine and cervical spine disabilities, and had she not begged for the October 2018 DBQ, the AOJ would never have separately service connected these neurologic abnormalities. Indeed, since the Veteran filed claims for increased ratings for her headaches and lumbar spine and cervical spine disabilities in August 2009, she has consistently reported what might be considered neurologic abnormalities extending from her head to her lower extremities. Additional medical guidance is thus needed to determine whether separate ratings for these abnormalities should be assigned prior to November 24, 2018. These matters are REMANDED for the following action: 1. Transfer this file to a VA examiner for an opinion addressing whether the Veteran had neurologic abnormalities associated with her lumbar spine disability and/or cervical spine disability prior to November 24, 2018. The examiner should review the file, including: (a) the Veteran’s assertion that there are objective findings of record dated as far back as 2010, including 2017 and 2018 DBQs, which establish lumbar spine and cervical spine neurologic involvement; (b) her statements submitted during the course of this appeal (since August 2009) describing radiating pain from her head to behind her eyes and ears, down her neck to her shoulders, chest and fingers and from her back to her lower extremities; and (c) all VA examination reports dated since May 2010. Based on the review and considering competent the Veteran’s reports of lay-observable symptomatology, the VA examiner should offer an opinion as to whether, prior to November 24, 2018, the Veteran had any neurologic abnormalities associated with her lumbar spine disability and/or cervical spine disability. The examiner should specifically indicate whether the radiating pain the Veteran reported during the course of this appeal represents the initial manifestations of the sciatica in her lower extremities and the radiculopathy in her upper extremities. (Continued on the next page)   The examiner should provide rationale for each opinion. 2. Adjudicate whether the Veteran is entitled to separate 10 percent ratings for right lower extremity sciatica and left lower extremity sciatica prior to November 24, 2018, and separate 20 percent ratings for right upper extremity radiculopathy and left upper extremity radiculopathy prior to November 24, 2018. Jenna Brant Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board L. N. 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.