Citation Nr: 21039778 Decision Date: 07/01/21 Archive Date: 07/01/21 DOCKET NO. 06-04 785 DATE: July 1, 2021 REMANDED Entitlement to separate disability rating for right lower extremity radiculopathy is remanded. Entitlement to separate disability rating for left lower extremity radiculopathy is remanded. Entitlement to service connection for a bladder disability is remanded. Entitlement to service connection for erectile dysfunction is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1984 to February 2004. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 2004 rating decision. Entitlement to separate disability ratings for bilateral lower extremity radiculopathy was remanded by the Board in September 2020. Unfortunately, the Veteran's claims must be remanded for further development. Although the Board sincerely regrets the additional delay, it is necessary to ensure that there is a complete record upon which to decide the Veteran's claims, so he is afforded every possible consideration. 1. Entitlement to a separate disability rating for right lower extremity radiculopathy is remanded. 2. Entitlement to a separate disability rating for left lower extremity radiculopathy is remanded. 3. Entitlement to service connection for a bladder disability is remanded. 4. Entitlement to service connection for erectile dysfunction is remanded. The issues of entitlement to separate disability ratings for bilateral lower extremity radiculopathy were remanded by the Board in September 2020 to obtain a medical opinion concerning an estimate of the severity and onset of the Veteran's neurological symptoms due to his service-connected residuals, lumbar laminectomy, with bilateral bone fusion and posterior lateral stabilization, intervertebral disc syndrome, degenerative arthritis, degenerative disc disease, and bilateral lower extremity radiculopathy. Pursuant to the Board's remand, the Agency of Original Jurisdiction obtained an October 2020 medical opinion. For the reasons discussed below, the Board finds that a new examination and medical opinion are necessary. The October 2020 medical opinion concludes that the Veteran's radicular signs have been present since at least June 2004, to varying degrees, and have continued throughout the appellate period. The Veteran's radicular symptoms have mostly been confined to his left lower extremity and have mostly been decreased sensation to light touch and/or pinprick. The medical opinion provides that prior to the November 2019 Back (Thoracolumbar Spine) Conditions Disability Benefits Questionnaire, the Veteran's motor strength did not appear to be affected. His straight leg raise was positive, then negative on a subsequent examination, which could represent deviations in technique by different examiners or differences in the perception of pain by the Veteran. The Veteran's symptoms have involved numbness, paresthesias, and dysthesias, primarily located in the left leg. The Board finds that the October 2020 medical opinion is inadequate as it does not sufficiently address severity of his left lower extremity radiculopathy. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (holding that when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate). While the medical opinion discusses the left lower extremity symptoms experienced by the Veteran, it does not state the severity of these symptoms. Further, the medical opinion does not discuss the severity and onset of all the Veteran's potential neurological symptoms associated with his service-connected lumbar spine disability. Under the General Rating Formula for Diseases and Injuries of the Spine, associated objective neurologic abnormalities should be evaluated separately under an appropriate diagnostic code. 38 C.F.R. § 4.71a, Note (1). In particular, the Veteran's private treatment records from June 2010 state that his neurogenic bladder dysfunction was caused by his lumbar herniated disc that he is currently experiencing and his prior surgery at the L5/S1 level. The Veteran's treatment records from the Kadena Medical Facility at United States Kadena Air Force Base, Japan state that he reported a sudden onset of male erectile disorder approximately three to four years ago without explanation. Additionally, following the completion of the October 2020 medical opinion, a significant number of treatment records discussing the severity of the Veteran's bilateral lower extremity radiculopathy were added to his claims folder. There is no indication that the examiner considered these medical records. Lastly, the Veteran's claims folder contains treatment records from a private treater in Japan that occurred in 2010. However, his treatment records from United States Naval Hospital Okinawa, Japan indicate that he advised of private treatment for neurological symptoms in 2015. Therefore, it appears that the Veteran's claims folder does not contain potentially relevant private treatment records. A remand is required to allow VA to obtain authorization and request these records. The matters are REMANDED for the following actions: 1. Obtain all outstanding treatment records from Kadena Medical Facility at United States Kadena Air Force Base, Japan and United States Naval Hospital Okinawa, Japan. 2. Ask the Veteran to complete a VA Form 21-4142 for any physicians and facilities relating to treatment for neurological symptoms due to his service-connected residuals, lumbar laminectomy, with bilateral bone fusion and posterior lateral stabilization, intervertebral disc syndrome, degenerative arthritis, degenerative disc disease, and bilateral lower extremity radiculopathy. Make two requests for the authorized records from all adequately identified physicians and facilities relating to treatment for neurological symptoms due to the Veteran's service-connected lumbar spine disability, unless it is clear after the first request that a second request would be futile. 3. After the above development is completed, schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of his bladder disability and erectile dysfunction and the severity of all of his neurological symptoms. The examiner must: (a.) Opine whether the Veteran's bladder disability and/or erectile dysfunction is at least as likely as not (50 percent probability or greater) proximately due to his service-connected residuals, lumbar laminectomy, with bilateral bone fusion and posterior lateral stabilization, intervertebral disc syndrome, degenerative arthritis, degenerative disc disease, and bilateral lower extremity radiculopathy. (b.) Opine whether the Veteran's bladder disability and/or erectile dysfunction is at least as likely as not (50 percent probability or greater) aggravated, i.e., worsened beyond its natural progression, by his service-connected residuals, lumbar laminectomy, with bilateral bone fusion and posterior lateral stabilization, intervertebral disc syndrome, degenerative arthritis, degenerative disc disease, and bilateral lower extremity radiculopathy. NOTE: The examiner is advised that a "permanent worsening" is not required to establish aggravation. Aggravation may include temporary worsening, or flare-ups, of a disability. The examiner must: (c.) Determine the current severity of all neurological symptoms related to his service-connected residuals, lumbar laminectomy, with bilateral bone fusion and posterior lateral stabilization, intervertebral disc syndrome, degenerative arthritis, degenerative disc disease, and bilateral lower extremity radiculopathy, including bilateral lower extremity radiculopathy, bladder disability, and erectile dysfunction. The examiner should provide a full description of the identified disabilities and report all signs and symptoms necessary for evaluating the Veteran's disabilities under the rating criteria. Saudiee Brown Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Mussey, Sean 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.