Citation Nr: 21025214 Decision Date: 04/27/21 Archive Date: 04/27/21 DOCKET NO. 14-26 051 DATE: April 27, 2021 ORDER Throughout the pendency of the appeal, entitlement to a 50 percent evaluation, but no higher, for service-connected right (major) carpal tunnel syndrome is granted, subject to the applicable regulations concerning the payment of monetary benefits. Throughout the pendency of the appeal, entitlement to a 40 percent evaluation, but no higher, for service-connected left (minor) carpal tunnel syndrome is granted, subject to the applicable regulations concerning the payment of monetary benefits Throughout the pendency of the appeal, entitlement to a 40 percent evaluation, but no higher, for service-connected degenerative arthritis of the lumbosacral spine is granted, subject to the applicable regulations concerning the payment of monetary benefits. REMANDED Entitlement to an initial evaluation in excess of 10 percent for service-connected limitation of extension of the left hip is remanded. Entitlement to a compensable initial evaluation for service-connected limitation of extension of the right hip is remanded. Entitlement to a compensable initial evaluation for service-connected limitation of flexion of the left hip is remanded. Entitlement to an evaluation in excess of 10 percent for service-connected limitation of flexion of the right hip is remanded. Entitlement to service connection for a neurologic disability of the left leg, to include radiculopathy, to include as secondary to a service-connected disability, is remanded. Entitlement to service connection for a neurologic disability of the right leg, to include radiculopathy, to include as secondary to a service-connected disability, is remanded. FINDINGS OF FACT 1. The most probative evidence reflects that, throughout the appeal period (from April 30, 2012, to the present), the manifestations of the Veteran's service-connected right (major) carpal tunnel syndrome were not wholly sensory, and most closely approximated "severe" incomplete paralysis of the median nerve, but without evidence of complete paralysis of such. 2. The most probative evidence reflects that, throughout the appeal period (from April 30, 2012, to the present), the manifestations of the Veteran's service-connected left (minor) carpal tunnel syndrome were not wholly sensory, and most closely approximated "severe" incomplete paralysis of the median nerve, but without evidence of complete paralysis of such. 3. Resolving all reasonable doubt in the Veteran’s favor, throughout the appeal period (from April 30, 2012, to the present), the Veteran's service-connected degenerative arthritis of the lumbosacral spine is manifested by forward flexion of the thoracolumbar spine of 30 degrees or less; however, the most probative evidence does not reflect favorable ankylosis of the cervical and/or thoracolumbar spine, or intervertebral disc syndrome. CONCLUSIONS OF LAW 1. From April 30, 2012, to the present, he criteria for 50 percent evaluation, but no higher, for the Veteran's service-connected right (major) carpal tunnel syndrome are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.123, 4.124, 4.124a, Diagnostic Code 8515. 2. 1. From April 30, 2012, to the present, he criteria for 50 percent evaluation, but no higher, for the Veteran's service-connected left (minor) carpal tunnel syndrome are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.123, 4.124, 4.124a, Diagnostic Code 8515. 3. From April 30, 2012, to the present, the criteria for a 40 percent evaluation, but no higher, for service-connected degenerative arthritis of the lumbosacral spine are met. 38 U.S.C. §§ 1155, 5102, 5103, 5103A, 5107; 38 C.F.R. §§ 3.159, 4.1, 4.2, 4.3, 4.7, 4.40, 4.45, 4.71a, Diagnostic Codes 5235 - 5243. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from October 1981 to June 1997. This matter comes to the Board of Veterans' Appeals (Board) from a January 2014 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO) of the Veterans Benefits Administration (VBA), which is the Agency of Original Jurisdiction (AOJ). The Veteran expressed timely disagreement with this determination, and the present appeal ensued. The Veteran and his wife testified at a videoconference Board hearing before the undersigned Veterans Law Judge (VLJ) in June 2017. A transcript of that hearing has been associated with the file. These appealed issues, among others, were previously before the Board in March 2018, when it was determined that a remand was necessary to ensure that VA fulfilled its duty to assist the Veteran. The Board’s remand directives and the subsequent actions of the AOJ will be discussed below. The Veteran’s appealed issues have been returned to the Board for further appellate consideration. In an April 2019 rating decision, the AOJ, among other actions, partially granted the Veteran’s appeal for an increased evaluation for his service-connected low back disability; the assigned 10 percent evaluation was increased to 40 percent, effective from October 23, 2018. This represented a partial allowance of this appealed issue and resulted in a "staged" evaluation. Since the appealed issue was not granted to the fullest extent, it remained in appellate status and has been recharacterized to reflect the “staged” evaluation resulting from the AOJ’s determination. See Hart v. Mansfield, 21 Vet. App. 505 (2007); AB v. Brown, 6 Vet. App. 35, 38-39 (1993). Issues not on appeal In the April 2019 rating decision, the AOJ also assigned separate 10 percent initial evaluations for impairment of rotation of the left and right hips, effective from October 23, 2018. Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997). As the Veteran did not express disagreement with these downstream matters in a timely fashion, neither are in appellate status. Archbold v. Brown, 9 Vet. App. 124 (1996). 1. Entitlement to an evaluation in excess of 10 percent for service-connected right (major) carpal tunnel syndrome 2. Entitlement to an evaluation in excess of 10 percent for service-connected left (minor) carpal tunnel syndrome Disability evaluations are determined by the application of a schedule of ratings, which is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. See 38 U.S.C. § 1155; 38 C.F.R. Part 4. The percentage ratings in VA's Schedule for Rating Disabilities (Rating Schedule) represent as far as can practicably be determined the average impairment in earning capacity resulting from such disabilities and their residual conditions in civil occupations. See 38 C.F.R. § 4.1. Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability more closely approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107 (b); 38 C.F.R. §§ 3.102, 4.3. Where entitlement to compensation has already been established and increase in disability is at issue, the present level of disability is of primary concern. See Francisco v. Brown, 7 Vet. App. 55 (1994). However, “staged” ratings are appropriate where the factual findings show distinct time periods when the service-connected disability exhibits symptoms that would warrant different ratings. See Hart, supra. Separate compensable evaluations may be assigned for separate periods of time if such distinct periods are shown by the competent evidence of record during the appeal, a practice known as “staged” ratings. See Fenderson v. West, 12 Vet. App. 119, 126 (1999). Once the evidence has been assembled, it is the Board’s responsibility to evaluate the evidence. 38 U.S.C. § 7104 (a). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The Veteran's service-connected bilateral carpal tunnel syndrome is currently evaluated under the criteria within 38 C.F.R. § 4.124a, Diagnostic Code 8515, pertinent to impairment of the median nerves. For rating purposes, a distinction is made between major (dominant) and minor groups. Handedness for the purpose of a dominant rating will be determined by the evidence of record, or by testing on VA examination. 38 C.F.R. § 4.69. To this point, the evidence unambiguously shows that the Veteran was right-hand dominant, and thus, the current issues involve his major (right) and minor (left) extremities. Under this Diagnostic Code, evaluations of 10 percent, 30 percent and 50 percent are assignable for incomplete paralysis of the median nerve of the major extremity which is mild, moderate or severe in degree, respectively. Evaluations of 10 percent, 20 percent, and 40 percent are assignable for incomplete paralysis of the median nerve of the minor extremity which is mild, moderate or severe in degree, respectively. Evaluations of 70 percent and 60 percent are also assignable for complete paralysis of the median nerves of the major and minor extremity, respectively. 38 C.F.R. § 4.124a, Diagnostic Code 8515. The term "incomplete paralysis" indicates a degree of lost or impaired function less than the type picture for complete paralysis given with each nerve. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. The Board also acknowledges that the terms "mild," "moderate," and "severe" are not defined in the Schedule. Rather than applying a mechanical formula, the Board must evaluate all of the evidence to the end that its decisions are "equitable and just." 38 C.F.R. § 4.6. The use of terminology such as "moderate" or "severe" by VA examiners and others, although an element of evidence to be considered by the Board, is not dispositive of an issue. All evidence must be evaluated in arriving at a decision regarding an increased rating. 38 C.F.R. §§ 4.2, 4.6. Evaluations are also offered for radicular nerve groups (upper, middle, lower, and all); however, as the Veteran’s carpal tunnel syndrome only affects the median nerves, application of Diagnostic Code 8515, specific to disabilities of only that nerve, is most appropriate. To this point, the Court has referred to "the canon of interpretation that the more specific trumps the general". Zimick v. West, 11 Vet. App. 45, 51 (1998) ("'a more specific statute will be given precedence over a more general one . . . . ") (quoting Busic v. United States, 446 U.S. 398, 406 (1980)]; see also Kowalski v. Nicholson, 19 Vet. App. 171, 176-7 (2005). Analysis The Veteran asserts that the manifestations of his service-connected bilateral carpal tunnel syndrome are more severe than the currently-assigned 10 percent evaluations. For the reasons discussed below, the Board concludes that the most probative evidence of record bolsters this contention, resulting in a partial allowance of the benefits sought throughout the appeal period. The current appeal stems from an intent to file a claim for an increased evaluation received by the AOJ on April 30, 2013. As the Veteran’s formal claim seeking these benefits was received within one year of this submission, the appeal period for consideration by the Board is from April 30, 2012, to the present. Gaston v. Shinseki, 605 F.3d 979, 984 (Fed. Cir. 2010). The evidence outlining the Veteran’s carpal tunnel syndrome symptoms and resulting functional impairment stems from his VA treatment records and the reports of January 2014 and December 2018 VA examinations. This evidence reflects that the Veteran’s service-connected bilateral carpal tunnel syndrome is manifested by pain and numbness of the hands and wrists, resulting in difficulty gripping and manipulating objects with his hands. Ultimately, the January 2014 and October 2018 VA examiners determined that the Veteran’s reports of pain and numbness were mild opined that the functional impairment resulting from the Veteran’s bilateral carpal tunnel syndrome was “mild” in severity. Initial review of this evidence reflects that the manifestations of this disability were wholly sensory, and thus, no more than “moderate” in severity. However, a closer reading of this evidence shows that the sensory impairment experienced by the Veteran also resulted in decreased strength, endurance, and dexterity in the hands and wrists. To this point, the October 2018 VA examiner clearly noted that the Veteran experienced increased pain and difficulty when manipulating equipment and tools with his hands. The Board concludes that this evidence is tantamount to neurological involvement beyond “wholly sensory” and most closely approximates “severe” incomplete paralysis of the median nerves. Critically, due to the retrospective nature of the October 2018 VA examiner’s statements, the Board finds that, resolving all reasonable doubt in the Veteran’s favor, the criteria for 50 percent (right/major) and 40 percent (left/minor) evaluations are met throughout the appeal period (December 30, 2012). To this extent, the Veteran’s appealed issues are partially granted. The Board has considered whether higher evaluations are warranted for these service-connected disabilities; however, the most probative evidence does not show that this disability manifests in complete paralysis either median nerve or involvement of another radicular nerve at any time during the appeal period. Further, the Board finds that the issue of an extraschedular rating has not been raised by the record and will not consider referral. Doucette v. Shulkin, 28 Vet. App. 366, 371 (2017). Lastly, as the record reflects that the Veteran remains employed despite the manifestations of his service-connected disabilities, entitlement to a total evaluation based on individual unemployability due to service-connected disabilities (TDIU) has not been raised by the record. Rice v. Shinseki, 22 Vet. App. 447, 452 (2009). 3. Entitlement to an increased evaluation for service-connected degenerative arthritis of the lumbosacral spine, currently evaluated 10 percent disabling prior to October 23, 2018, and 40 percent disabling, thereafter Disability of the musculoskeletal system is primarily the inability, due to damage or infection in the parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. It is essential that the examination on which ratings are based adequately portray the anatomical damage and the functional loss with respect to all of these elements. In evaluating disabilities of the musculoskeletal system, it is necessary to consider, along with the scheduler criteria, functional loss due to flare-ups of pain, fatigability, incoordination, pain on movement, and weakness. DeLuca v. Brown, 8 Vet. App. 202 (1995); Sharp v. Shulkin, 29 Vet. App. 26, 34 (2017); VAOPGCPREC 9- 98. The functional loss may be due to absence of part, or all, of the necessary bones, joints and muscles, or associated innervation, or other pathology and evidenced by visible behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. § 4.40. Pain on movement, swelling, deformity or atrophy of disuse as well as instability of station, disturbance of locomotion, interference with sitting, standing and weight bearing are relevant considerations for determination of joint disabilities. 38 C.F.R. § 4.45. Painful, unstable, or malaligned joints, due to healed injury, are entitled to at least the minimal compensable rating for the joint. 38 C.F.R. § 4.59. Under VA regulations, separate disabilities arising from a single disease entity are to be rated separately. See 38 C.F.R. § 4.25 (2017); see also Esteban v. Brown, 6 Vet. App. 259, 261 (1994). The Veteran's service-connected degenerative disc disease of the lumbar spine is currently evaluated under the criteria of 38 C.F.R. § 4.71a, Diagnostic Codes 5242, relating to degenerative arthritis of the spine. Nonetheless, all service-connected disabilities of the thoracolumbar sine are evaluated under the criteria within the General Rating Formula for Diseases and Injuries of the Spine (Diagnostic Codes 5235 - 5242) and/or the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes (Diagnostic Code 5243). Regarding the latter, the Board notes that the medical evidence does not show, and the Veteran does not contend, that his service-connected low back disability involves a diagnosis of intervertebral disc syndrome of the thoracolumbar spine. For diagnostic codes 5235 to 5242, the General Rating Formula for Diseases and Injuries of the Spine provides that with or without symptoms such as pain, stiffness, or aching in the area of the spine affected by residuals of injury or disease the following ratings will apply: A 10 percent rating is provided for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, forward flexion of the cervical spine greater than 30 degrees but not greater than 40 degrees; or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, combined range of motion of the cervical spine greater than 170 degrees but not greater than 335 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or an abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height. Id. A 20 percent rating is assigned for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees; or, the combined range of motion of the thoracolumbar spine not greater than 120 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. Id. A 40 percent rating is warranted when medical evidence shows forward flexion of the thoracolumbar spine to 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. Id. A 50 percent rating is warranted if there is unfavorable ankylosis of the entire thoracolumbar spine. Id. A 100 percent rating is warranted if there is unfavorable ankylosis of the entire spine. Id. The criteria recounted above are disjunctive. Johnson v. Brown, 7 Vet. App. 95 (1994) (only one disjunctive "or" requirement must be met in order for an increased rating to be assigned); compare Melson v. Derwinski, 1 Vet. App. 334 (1991) (use of the conjunctive "and" in a statutory provision meant that all of the conditions listed in the provision must be met). Ankylosis is "immobility and consolidation of a joint due to a disease, injury, surgical procedure." See Lewis v. Derwinski, 3 Vet. App. 259 (1992) (citing Saunders Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health at 68 (4th Ed. 1987)). Note (1) to the rating formula specifies that any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, should be separately evaluated under an appropriate diagnostic code. Note (2): (See also Plate V.) For VA compensation purposes, normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, left and right lateral flexion are zero to 30 degrees, and left and right lateral rotation are zero to 30 degrees. The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined range of motion of the thoracolumbar spine is 240 degrees. The normal ranges of motion for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion. 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 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 Veteran's 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 (zero degrees) always represents favorable ankylosis. Note (6): Separately evaluate disability of the thoracolumbar and cervical spine segments, except when there is unfavorable ankylosis of both segments, which will be rated as a single disability. Analysis The Veteran contends that his service-connected low back disability is more severe than is reflected by the “staged” evaluation assigned by the AOJ. For the reasons discussed below, the Board concludes that, resolving all doubt in the Veteran’s favor, the medical evidence of record supports his assertions, and thus, the benefits sought are partially granted throughout the appeal period (since April 30, 2012). Gaston v. Shinseki, 605 F.3d 979, 984 (Fed. Cir. 2010). The evidence detailing the Veteran’s low back symptoms and resulting functional impairment stems from his VA treatment records and the reports of January 2014 and December 2018 VA examinations. While the January 2014 VA examination report does not reflect limitation of motion of the thoracolumbar spine meeting or closely approximating the criteria for an evaluation in excess of 10 percent under the pertinent rating criteria, the Board notes that such is largely inadequate for the purpose of readjudicating the Veteran’s appeal. Specifically, the January 2014 VA examiner did not provide range of motion findings pertaining to the Veteran’s low back during a flare-up of symptoms, as is necessary under the United States Court of Appeals for Veteran's Claims’ s (Court’s) holding in Sharp v. Shulkin, 29 Vet. App. 26, 34 (2017). Further, it appears that the January 2014 VA examiner did not take into account the Veteran’s need for pain medications, particularly injections of dilaudid, prescribed to the Veteran for treatment of his low back pain. To the above points, it appears that the AOJ partially granted the Veteran’s appealed issue based on such findings by the December 2018 VA examiner; however, these findings were not provided retrospectively. Chotta v. Peake, 22 Vet. App. 80 (2008). The Board has considered the propriety of remanding this appealed issue to the AOJ to obtain appropriate retrospective opinions; however, such is not necessary because the Veteran’s VA treatment records throughout the appeal period are more congruent with the findings of the October 2018 VA examiner. Soyini v. Derwinski, 1 Vet. App. 540 (1991). In light of above, the Board will resolve all reasonable doubt in the Veteran’s favor and apply the findings of the October 2018 VA examination throughout the entirety of the appeal period (since April 30, 2012). In doing so, the Board concludes that the criteria for a 40 percent evaluation are closely approximated since April 30, 2012. As such, the question before the Board is whether the criteria for an even higher evaluation may be assigned at any time since April 30, 2012. To this point, there is no evidence, to include from the Veteran, that his service-connected low back disability has been manifested by ankylosis of any segment of the spine at any time during the appeal period. Accordingly, the criteria for an evaluation in excess of 40 percent are not met or closely approximated during the appeal period, and an evaluation in excess of 40 percent may not be assigned. Further, the Board finds that the issue of an extraschedular rating has not been raised by the record and will not consider referral. Doucette v. Shulkin, 28 Vet. App. 366, 371 (2017). Lastly, as the record reflects that the Veteran remains employed despite the manifestations of his service-connected disabilities, entitlement to a total evaluation based on individual unemployability due to service-connected disabilities (TDIU) has not been raised by the record. Rice v. Shinseki, 22 Vet. App. 447, 452 (2009). REASONS FOR REMAND 1. Entitlement to an initial evaluation in excess of 10 percent for service-connected limitation of extension of the left hip is remanded. 2. Entitlement to a compensable initial evaluation for service-connected limitation of extension of the right hip is remanded. 3. Entitlement to a compensable initial evaluation for service-connected limitation of flexion of the left hip is remanded. 4. Entitlement to an evaluation in excess of 10 percent for service-connected limitation of flexion of the right hip is remanded. Unfortunately, another remand is necessary because the January 2014 and October 2018 VA hip examination reports are inadequate for the purpose of readjudicating the Veteran’s appealed issues. Specifically, the October 2018 VA examiner did not retrospectively provide range of motion findings for the Veteran’s hips during a flare-up of symptoms. Further, it appears that the examiners may have taken into account the ameliorating effects of the Veteran's dilaudid injections when discerning the range of motion of his hips, which the Court has found to be improper unless the VA Rating Schedule actually contemplates such, which the Diagnostic Codes pertinent to rating the hips do not. Jones v. Shinseki, 26 Vet. App. 56 (2012). In light of above, the Board concludes that these appealed issues must be remanded in order to provide the Veteran an adequate VA hip examination which also provides retrospective findings congruent with the controlling holdings of the Court. 5. Entitlement to service connection for a neurologic disability of the left leg, to include radiculopathy, to include as secondary to a service-connected disability, is remanded. 6. Entitlement to service connection for a neurologic disability of the right leg, to include radiculopathy, to include as secondary to a service-connected disability, is remanded. The Veteran contends that he experiences neurological symptoms of the legs that are either due to his in-service parachute jumps or caused or aggravated by a service-connected disability. The Veteran was provided a VA examination to determine the nature and etiology of his neurology disability of the legs in October 2018. Unfortunately, the Board concludes that another remand is necessary because the opinions provided by the October 2018 VA examiner are inadequate for the purpose of readjudicating these appealed issues. Specifically, the VA examiner’s opinion that the Veteran neurological disability of the legs was not as likely as not caused or aggravated by his service-connected low back disability was premised on low back testing completed in 2010 and 2012. As noted in the decision above, the Veteran’s service-connected low back disability has progressed since this testing was completed, and thus, contemporaneous testing may show that this progression includes neurological involvement. Further, the October 2018 VA examiner did not provide a rationale for the unfavorable direct nexus opinion aside noting that the Veteran’s service treatment records were devoid of a diagnosis of a neurological disability of the legs. As this rational is contrary to the controlling VA laws, another direct nexus opinion must be sought and obtained. 38 C.F.R. § 3.303 (d). The matters are REMANDED for the following actions: 1. The AOJ must obtain and associate with the file all updated records of VA treatment pertaining to the Veteran. 2. The AOJ must ask the Veteran to identify and complete releases for all private treatment records associated with the disabilities subject to this remand. For each release that the Veteran completes and submits, the AOJ must make two attempts to obtain the identified records and notify the Veteran if any such records cannot be acquired. 3. Thereafter, the AOJ must request that the Veteran be scheduled for an orthopedic VA examination to evaluate his service-connected bilateral hip disabilities and to determine the existence, nature, and etiology of any radicular symptoms affecting the Veteran’s lower extremities. The complete electronic record must be made available to, and reviewed by, the VA examiner prior to conducting the examination. All necessary studies and tests should be conducted. The examiner must describe the frequency and severity of the manifestations of the Veteran’s service-connected bilateral hip disabilities. *To the degree possible, it would be helpful to schedule the Veteran for a VA examination during a flare-up of his service-connected his disabilities. If it is necessary to undertake separate examinations, this should be accomplished. *In addition to the information requested by the standard DBQ relating to disabilities of the hips, the examiner must specifically address the following: - Provide findings for limitation of motion (expressed in degrees) for the Veteran’s hips during flare-ups of symptoms, currently and retrospectively. In doing so, please review the January 2014 VA examination report, and based on the information therein, provide the requested findings. * The examiner is specifically requested to provide the requested findings when discounting the ameliorative effects of medication(s), to include the Veteran’s dilaudid injections. For the Veteran’s diagnosed neurological disability of the legs, the examiner must address the following: a. Is the diagnosed disability at least as likely as not caused by a service-connected disability? b. Is the diagnosed disability at least as likely as not aggravated by a service-connected disability? c. Is the diagnosed disability at least as likely as not proximately due to or the result of any incident of the Veteran’s service, to specifically include his parachute jumps? If the examiner cannot provide an opinion without resorting to mere speculation, this should be so stated along with supporting rationale. In so doing, the examiner shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to the particular question. 4. After undertaking any additional development deemed appropriate, and giving the Veteran full opportunity to supplement the record, adjudicate the Veteran's pending issues in light of any additional evidence added to the record. If any benefit sought on appeal is not granted to the fullest extent, the Veteran and his representative should be furnished with a copy of this readjudication and be afforded the applicable opportunity to respond. Michael J. Skaltsounis Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Scott W. Dale, 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.