Citation Nr: 21026264 Decision Date: 04/30/21 Archive Date: 04/30/21 DOCKET NO. 15-37 534 DATE: April 30, 2021 ORDER A rating in excess of 10 percent prior to March 31, 2010, for lumbar thoracic degenerative disc disease (hereinafter thoracolumbar spine disorder) is denied. A rating in excess of 20 percent from March 31, 2010, for a thoracolumbar spine disorder is denied. A rating in excess of 20 percent from December 22, 2020 for right lower extremity (RLE) radiculopathy is denied. REMANDED Entitlement to a separate rating for left lower extremity (LLE) radiculopathy is remanded. Entitlement to a separate rating for right lower extremity (RLE) radiculopathy prior to December 22, 2020 is remanded. FINDINGS OF FACT 1. Prior to March 31, 2010, the Veteran’s thoracolumbar spine disorder was not manifested by forward flexion of the thoracolumbar spine to 60 degrees or less, or muscle spasms or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. 2. From March 31, 2010, the Veteran’s thoracolumbar spine disorder has not been manifested by forward flexion of the thoracolumbar spine to 30 degrees or less, favorable ankylosis of the entire thoracolumbar spine, or incapacitating episodes requiring bed rest prescribed by a doctor. 3. From December 22, 2020, the Veteran’s RLE radiculopathy has been productive of no more than moderate symptomatology. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 10 percent prior to March 31, 2010, for a thoracolumbar spine disorder have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code (DC) 5242. 2. The criteria for a rating in excess of 20 percent from March 31, 2010, for a thoracolumbar spine disorder have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, DC 5242. 3. From December 22, 2020, the criteria for an initial rating in excess of 20 percent for RLE radiculopathy have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.124a, DC 8520. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Air Force from May 1955 to May 1981. In March 2019 and November 2020, the Board of Veterans’ Appeals (Board) remanded this case for additional development. As an initial matter, the record reflects that the Veteran received a letter in October 2020 indicating he could request a virtual tele-hearing instead of waiting for a travel board hearing. Upon further review, the Veteran does not have a pending hearing request as he was scheduled for a hearing before the Board in January 2019 and failed to attend that hearing. Therefore, the Veteran’s hearing request is considered withdrawn. Increased Rating Disability ratings are determined by applying the criteria set forth in VA’s Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1. The basis of disability evaluations is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment. 38 C.F.R. § 4.10. In determining the severity of a disability, the Board is required to consider the potential application of various other provisions of the regulations governing VA benefits, whether or not they were raised by the veteran, as well as the entire history of the veteran’s disability. 38 C.F.R. §§ 4.1, 4.2; Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991). In deciding this appeal, the Board has considered whether separate ratings for different periods of time, based on the facts found, are warranted, a practice of assigning ratings referred to as “staging the ratings.” See Hart v. Mansfield, 21 Vet. App. 505 (2007). Disability of the musculoskeletal system is primarily the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. 38 C.F.R. §§ 4.40. It is important that when evaluating disabilities of the musculoskeletal system, functional loss due to pain and weakness causing additional disability beyond that reflected on range of motion measurements must be considered. See 38 C.F.R. §§ 4.40; DeLuca v. Brown, 8 Vet. App. 202 (1995). Consideration must also be given to weakened movement, excess fatigability and incoordination. 38 C.F.R. §§ 4.45. It is the intent of the schedule to recognize painful motion with joint or periarticular pathology as productive of disability. It is also the intention to recognize actually painful, unstable, or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. 38 C.F.R. §§ 4.59. For the entire period on appeal, the Veteran’s thoracolumbar spine disorder has been rated pursuant to diagnostic code (DC) 5243 for intervertebral disc syndrome (IVDS). Nevertheless, the Board has recharacterized the diagnostic code to 5242 for degenerative disc disease (DDD), for the entirety of the appeal period. Such recharacterization is appropriate as it reflects that DDD is the correct diagnosis for the Veteran’s service-connected thoracolumbar spine disorder. Furthermore, the Board notes that despite undergoing numerous VA examinations, the Veteran was never diagnosed with IVDS. Rather, the examinations consistently reveal diagnoses of DDD of the spine. See July 2015 VA Examination; see also December 2020 VA Examination. The Board has considered the implications of changing the diagnostic code and recognizes that any such change must be explained. Pernorio v. Derwinski, 2 Vet. App. 625 (1992). Here, the change in code does not impact the Veteran. Both 5242 and 5243 are considered under the General Rating Formula for Diseases and Injuries of the Spine (General Rating Formula), unless 5243 is evaluated under the Formula for Rating IVDS based on incapacitating episodes. Here, the prior rating decisions applied the General Rating Formula rather than the Formula for rating IVDS. Thus, there is no prejudice in changing the Veteran’s rating diagnostic code to 5242. For the foregoing reasons, the Veteran’s disability is currently rated under Diagnostic Code 5242 for degenerative disc disease. While portions of the rating schedule addressing the musculoskeletal system were revised effective February 7, 2021, this diagnostic code was not changed. The Veteran’s thoracolumbar spine disorder is rated under DC 5242 for degenerative disc disease, pursuant to the General Rating Formula for Diseases and Injuries of the Spine. Under this rating criteria, a 10 percent disability rating is warranted for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height. A 20 percent disability rating is assigned 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 disability rating is assigned for forward flexion of the thoracolumbar spine of 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent disability rating is assigned for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent disability rating is assigned for unfavorable ankylosis of entire spine. 38 C.F.R. § 4.71a. As explained below, there is no evidence the Veteran has intervertebral disc syndrome (IVDS). As such, the specific rating criteria that pertain to IVDS will not be considered herein. 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. 38 C.F.R. § 4.71a, Note (2). The Board must also analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. Gabrielson v. Brown, 7 Vet. App. 36, 39- 40 (1994). Competency of evidence differs from weight and credibility. Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while credibility is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994). 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 veteran. See 38 U.S.C. § 5107; 38 C.F.R. § § 3.102. 1. Entitlement to a rating in excess of 10 percent prior to March 31, 2010 for a thoracolumbar spine disorder. The Veteran contends that he is entitled to an increased disability rating for his service-connected thoracolumbar spine disorder for the period prior to March 31, 2010. After a thorough review of the record, the Board has determined that the Veteran’s disorder does not warrant a rating in excess of 10 percent for this period. The Veteran was initially awarded service connection for his thoracolumbar spine disorder in a June 2009 rating decision. See June 2009 Rating Decision. The most probative and relevant evidence pertaining to the Veteran’s thoracolumbar spine disorder, for the period prior to March 31, 2010, is a June 2009 VA Examination. The results from this examination ultimately led to an award of service connection for the Veteran’s thoracolumbar spine disorder in the June 2009 rating decision. In the June 2009 VA examination, the Veteran complained of severe and constant low back pain, which radiated to his legs. The Veteran reported flare-ups every 3 to 4 months, which lasted 1 to 2 days. No incapacitating episodes were noted. Regarding physical limitations, the Veteran reported he could walk more than a quarter but less than a full mile. No ankylosis, scoliosis, lordosis, or kyphosis were noted. The Veteran showed guarding and tenderness; however, no spasms, atrophy, pain with motion, or weakness was noted. Active range of motion of the thoracolumbar spine was recorded at: flexion 0 to 80 degrees, extension 0 to 20 degrees, right and left lateral flexion 0 to 20 degrees, and right and left lateral rotation 0 to 20 degrees. Objective evidence of pain was noted on active range of motion and repetitive motion, but no additional limitation after three repetitions was recorded. Imaging studies were performed, which found L5/S1 discogenic degenerative changes of moderate degree and loss of disc height. See June 2009 VA Examination. After reviewing the foregoing evidence, the Board finds that the criteria for a rating in excess of 10 percent prior to March 31, 2010 for a thoracolumbar spine disorder have not been met. In pertinent part, for this period, the evidence of record did not show a limitation of 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 abnormal gait, or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. Additionally, no diagnosis of IVDS was found for this period. The Board acknowledges that VA examinations must include joint testing for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint. 38 C.F.R. § 4.59; Correia, 28 Vet. App. at 158. VA examiners must also "express an opinion on whether pain could significantly limit functional ability" and the examiner's determination in such regard "should, if feasible, be portrayed in terms of the degree of additional range-of-motion loss due to pain on use or during flare-ups." Sharp, 29 Vet. App. at 33. The Board has carefully considered the VA examination of record and whether it complied with Correia and Sharp. Significantly, however, to the extent that the examination findings of record relative to the thoracolumbar spine are not completely in compliance with Correia and/or Sharp, the Board finds that remand for additional examination would serve no useful purpose. Soyini, 1 Vet. App. at 546. In that regard, the Board emphasizes that current examination findings would not be useful in adjudicating the rating assigned for the period prior to March 31, 2010, and any retrospective opinion would merely impose an additional burden on VA with no benefit flowing to the Veteran, as VA would be asking the examiner to speculate as to the pre- March 31, 2010 ranges of motion. Accordingly, the preponderance of the evidence is against a rating in excess of 10 percent prior to March 31, 2010 for a thoracolumbar spine disorder. In reaching the conclusion above, the Board considered the doctrine of reasonable doubt, however, as the preponderance of the evidence is against the Veteran’s claim, the doctrine is not for application. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 2. Entitlement to a rating in excess of 20 percent from March 31, 2010 for a thoracolumbar spine disorder. The Veteran contends that he is entitled to an increased disability rating for his service-connected thoracolumbar spine disorder for the period from March 31, 2010. After a thorough review of the record, the Board has determined that the evidence does not warrant a rating in excess of 20 percent for this period. In May 2010, the Veteran underwent a VA examination to evaluate his thoracolumbar spine disorder. During the examination, the Veteran reported that his thoracolumbar spine pain had progressed and become more frequent since his June 2009 VA examination. Specifically, he claimed that his pain was aggravated by wrong movements, weather changes, and lifting 10 to 15 pounds. The Veteran reported a history of fatigue, decreased motion, and spasms. Additionally, he reported that, while he was able to walk more than a quarter mile, he could not walk a full mile. The examiner noted that the Veteran’s posture, gait, and head position were normal, and that his spine was symmetrical in appearance. No kyphosis, lordosis, scoliosis, reverse lordosis, or thoracolumbar spine ankylosis were noted. Spasms, guarding, tenderness, and pain with motion were recorded; however, none were found to be severe enough to be responsible for an abnormal gait or spinal contour. Thoracolumbar spine range of motion was recorded at flexion 0 to 50 degrees, extension 0 to 20 degrees, right and left lateral flexion 0 to 20 degrees, and right and left lateral rotation 0 to 20 degrees. Objective evidence of pain on active range of motion was noted; however, objective evidence of pain was not recorded following repetitive motion, and no additional limitations were found after three repetitions. The mid-thoracic paraspinal muscles were tender to palpation, and this was manifested verbally and by face grimace. Ultimately, the examiner diagnosed the Veteran with degenerative disc disease of the lumbar/thoracic spine. See May 2010 VA Examination. In December 2012, the Veteran complained of pain in the upper right lumbar area. See VA treatment record received June 2013. In August 2013, the Veteran reported to VA clinicians that he had lower back pain, which began after he was lifting some items and felt a pop. He was subsequently diagnosed with a lumbar spine strain. See VA Treatment Record received September 2014. In July 2015, the Veteran was afforded another VA examination to evaluate his thoracolumbar spine disorder. Range of motion was recorded as: forward flexion 0 to 45 degrees, extension 0 to 15 degrees, right and left lateral flexion 0 to 20 degrees, and right and left lateral rotation 0 to 20 degrees. The Veteran was able to perform repetitive use testing with at least 3 repetitions. Range of motion after repetitive use testing was recorded at: forward flexion 0 to 45 degrees, extension 0 to 10 degrees, right and left lateral flexion 0 to 15 degrees, and right and left lateral rotation 0 to 15 degrees. The Veteran was found to have functional loss consisting of less movement than normal and pain on movement due to his thoracolumbar spine disorder. No localized tenderness or pain on palpation for joints and/or soft tissue, guarding or muscle spasm of the thoracolumbar spine was recorded. Muscle strength testing yielded all normal results and no muscle atrophy was noted. The examiner did not find IVDS of the thoracolumbar spine. See July 2015 VA Examination. In September 2015, the Veteran attended a primary care appointment and reported back pain. See September 2016 VA treatment record. In January 2017, the Veteran reported that approximately six months prior he had fallen down several stairs, landed on his back, and had been suffering back pain ever since. See VA treatment Records received April 2017. Imaging studies from June 2019 revealed lumbar degenerative disc disease and lumbar facet arthropathy. Additionally, an August 2019 VA treatment record indicated that the Veteran had lumbar spine pain and reduced range of motion. See VA Treatment Record received October 2019. In October 2019, the Veteran underwent a private MRI of the lumbar spine. He was diagnosed with severe canal as well as bilateral foraminal stenosis at L4-5 due to a broad-based disc protrusion with facet hypertrophy and ligamentum flavum thickening. At L5-S1, there was a diffuse disc bulge with a right paracentral broad-based protrusion extending into the right subarticular recess with right S1 nerve root impingement. Additionally, a mild disc bulge was seen at L3-4. See Private Treatment Record received December 2019. In December 2020, the Veteran underwent a VA examination to evaluate his thoracolumbar spine disorder. During the examination, Veteran reported that his back pain had worsened. Additionally, he indicated that he suffered daily flareups that he described as moderate to severe, which lasted days and sometimes weeks. Due to his back condition, the Veteran reported he had difficulty with lifting and also had a limited range of motion. Range of motion was recorded at: forward flexion 0 to 60 degrees, extension 0 to 20 degrees, right and left lateral flexion 0 to 20 degrees, and right and left lateral rotation 0 to 20 degrees. Pain was noted on all movements during the range of motion test, and also during weight bearing. After three repetitions, range of motion was recorded at: forward flexion 0 to 55 degrees, extension 0 to 15 degrees, right and left lateral flexion 0 to 15 degrees, right and left lateral rotation 0 to 15 degrees. Range of motion after repeated use over time was described as: forward flexion 0 to 50 degrees, extension 0 to 10 degrees, right and left lateral flexion 0 to 10 degrees, right and left lateral rotation 0 to 10 degrees. The examination was not conducted during a flare-up; however, range of motion was described as 0 to 45 degrees for forward flexion, 0 to 10 degrees for extension, and 0 to 10 degrees for right and left lateral flexion and rotation. The examiner found no guarding, muscle spasms, ankylosis, or IVDS of the thoracolumbar spine. Additionally, the Veteran reported occasionally using a cane. Finally, the examiner noted that there was objective evidence of pain on passive range of motion testing of the back and on non-weight bearing testing of the back. The examiner diagnosed lumbar thoracic degenerative disc disease with right lower radiculopathy. See December 2020 VA Examination. After reviewing the foregoing, the Board finds that the criteria for a rating in excess of 20 percent from March 31, 2010 for a thoracolumbar spine disorder have not been met. In pertinent part, for this period, the evidence of record does not show limitation of flexion of the thoracolumbar spine to 30 degrees or less, ankylosis of the spine, or IVDS with incapacitating episodes requiring bed rest prescribed by a doctor. Accordingly, the preponderance of the evidence is against a rating in excess of 20 percent from March 31, 2010 for a thoracolumbar spine disorder. In reaching the conclusion above, the Board considered the doctrine of reasonable doubt, however, as the preponderance of the evidence is against the Veteran’s claim, the doctrine is not for application. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 3. Entitlement to a rating in excess of 20 percent from December 22, 2020 for right lower extremity radiculopathy. Pursuant to Note (1) of the General Rating Formula, associated neurological abnormalities are considered to be part and parcel of the Veteran's lumbar spine disorder. In a January 2021 rating decision, the Agency of Original Jurisdiction (AOJ) granted service connection for right lower extremity (RLE) radiculopathy and assigned a 20 percent rating, effective, December 2020, based on evidence of moderate incomplete paralysis. The AOJ also advised this matter was considered intertwined with the claim on appeal for an increased rating for the thoracolumbar spine disorder. Accordingly, the Board will now consider if a higher rating for radiculopathy is warranted for the period on appeal. The Veteran’s RLE radiculopathy is currently rated under DC 8520 for paralysis of the sciatic nerve. Under DC 8520, an 80 percent disability rating is assigned for complete paralysis of the sciatic nerve, demonstrated by foot drop, no active movement possible of the muscles below the knee, and knee flexion that is weakened or (very rarely) lost. Lower disability ratings are provided for incomplete paralysis, defined by the Rating Schedule as "a degree of lost or impaired function substantially less than the type picture for complete paralysis given." A 60 percent disability rating is assigned for severe, incomplete paralysis, with marked muscular atrophy. A 40 percent disability rating is assigned for moderately severe, incomplete paralysis. A 20 percent disability rating is assigned for moderate, incomplete paralysis. A 10 percent rating is assigned for mild incomplete paralysis. 38 C.F.R. § 4.124a. In December 2020, the Veteran underwent a VA examination to examine his thoracolumbar spine. During the examination, the Veteran displayed moderate intermittent pain in the RLE, moderate paresthesias and/or dysesthesias in the RLE, and mild numbness in the RLE. A straight leg raising test was performed and yielded positive results on the right leg. Ultimately, the examiner diagnosed the Veteran with moderate RLE radiculopathy involvement of the L4/L5/S1/S2/S3 nerve roots (sciatic nerve). See December 2020, VA examination. Aside from the December 2020 VA examination, there is no other evidence pertaining to the Veteran’s RLE radiculopathy for this period. In light of the evidence above and the governing legal authority, the Board finds that a rating in excess of 20 percent for RLE radiculopathy from December 22, 2020 is not warranted. Namely, the December 2020 VA examination revealed no more than moderate RLE radiculopathy. A higher 40 percent rating for radiculopathy requires a showing of moderately severe nerve damage. For this period, this has not been shown. 38 C.F.R. § 4.124a, DC 8520. REASONS FOR REMAND 1. Entitlement to a separate rating for left lower extremity radiculopathy, and entitlement to a separate rating for right lower extremity radiculopathy prior to December 22, 2020 are remanded. After a thorough review of the evidence, the Board finds that the record contains conflicting evidence regarding whether the Veteran has LLE radiculopathy, and if so, how severe the condition is. Similarly, the Board finds that the record is unclear as to whether the Veteran had RLE radiculopathy prior to December 22, 2020, and, if so, what symptoms are attributable to the condition, and how severe the condition was. In October 2011, the Veteran was given a provisional diagnosis of lumbar radiculopathy after reporting to VA clinicians with complaints of low back pain that radiated into his RLE. An electromyography (EMG) of the right side was ordered and conducted; however, the examination yielded normal results. See VA Treatment Record received June 2013. In a July 2015 VA examination, the examiner indicated that the Veteran displayed no radicular symptoms associated with his thoracolumbar spine condition. See July 2015 VA Examination. A March 2018 VA treatment note shows that the Veteran underwent a podiatric evaluation, which revealed diminished epicritic sensation bilaterally. In June 2019, the Veteran reported to the emergency department with complaints of low back pain that radiated bilaterally into his legs and hips. Clinicians indicated that their impression of the symptoms was bilateral hip pain and low back pain with bilateral radiculopathy. Imaging studies were performed, and the treating physicians noted progression of diffuse mild-to-moderate degenerative joint disease most severe in the lower lumbar spine. Additionally, mild disc space narrowing was found at L4-L5 and moderate to severe disc space narrowing was found at L5-S1. In August 2019, the Veteran again reported to VA clinicians with complaints of bilateral hip pain and low back pain with radicular symptoms. In September 2019, the Veteran visited an aquatic therapy center for initial evaluation for treatment for joint pain and discomfort. Among other things, the evaluation found low back pain and abnormal hip reflexes. See VA Treatment Record Received January 2020. Most recently, in December 2020, the Veteran underwent a VA examination to evaluate his thoracolumbar spine. Notably, the examiner found no symptoms indicating LLE radiculopathy. See December 2020 VA Examination. After considering the evidence above, the Board finds that the record suggests that the Veteran may suffer from LLE radiculopathy. In this regard, the record contains evidence indicating that the Veteran has suffered from radicular pain bilaterally in his lower extremities. Furthermore, the record appears to suggest that the Veteran’s bilateral hip pain and diminished hip reflexes may be a radicular symptom associated with his thoracolumbar spine condition. The Board also notes that the most recent VA examination did not reveal any left side radicular symptoms. Similarly, the record is unclear as to what symptoms are attributable to the Veteran’s RLE, and therefore the record is unclear as to when the Veteran’s RLE radiculopathy had its onset. Accordingly, the Board finds that a clarifying medical opinion is needed to address whether the Veteran had RLE radiculopathy prior to December 22, 2020, and what symptoms are attributable to the condition. Additionally, the Board finds that an opinion is needed to address whether the Veteran has LLE radiculopathy, and, if so, what symptoms are attributable to the condition. The matters are REMANDED for the following action: Obtain a VA addendum opinion from an appropriate examiner addressing whether the Veteran had RLE radiculopathy prior the December 22, 2020. If the Veteran is found to have had RLE radiculopathy prior to December 22, 2020, the examiner is asked to describe what symptoms are attributable to the condition, and to rate its severity. The examiner is also asked to opine whether the Veteran has LLE radiculopathy. If the Veteran is found to have LLE radiculopathy, the examiner should opine on the severity the condition, and indicate what symptoms are attributable to the condition. In forming the above opinions, the examiner is asked to specifically address: the March 2018 VA podiatric evaluation showing diminished epicritic sensation bilaterally, the June 2019 VA treatment notes showing clinical impressions of bilateral hip pain and low back pain with bilateral radiculopathy, and the September 2019 aquatic therapy note showing abnormal hip reflexes. The claims folder (including a copy of this remand) must be provided to, and reviewed by, the examiner as part of the examination. All indicated tests should be accomplished, and all clinical findings should be reported in detail. If the examiner determines that a physical examination of the Veteran is necessary to provide the requested opinions, such should be scheduled. A. ISHIZAWAR Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Talton, John H. 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.