Citation Nr: 22016605 Decision Date: 03/22/22 Archive Date: 03/22/22 DOCKET NO. 14-18 951 DATE: March 22, 2022 ORDER Entitlement to an effective date prior to March 24, 2009 for the grant of service connection for a bladder disability associated with multiple sclerosis is denied. Entitlement to an effective date of September 21, 2007, but no earlier, for the grant of service connection for right eye optic neuritis with diplopia associated with multiple sclerosis is granted. Entitlement to an effective date prior to October 25, 2010 for the grant of service connection for bowel functional impairment associated with multiple sclerosis is denied. Entitlement to an effective date prior to September 19, 2011 for the grant of service connection for a cervical spine disability associated with multiple sclerosis is denied. Entitlement to an effective date prior to September 21, 2007 for the grant of service connection for left upper extremity disability associated with multiple sclerosis is denied. Entitlement to an effective date prior to March 9, 2015 for the grant of service connection for swallowing difficulties associated with multiple sclerosis is denied. Entitlement to an effective date of February 12, 2010, but no earlier, for the grant of service connection for right upper extremity loss of strength and sensation associated with multiple sclerosis is granted. REMANDED Entitlement to service connection for a left shoulder disability is remanded. Entitlement to an initial evaluation in excess of 20 percent for multiple sclerosis with a left upper extremity disability, to include separate evaluation for multiple sclerosis, is remanded. Entitlement to an initial evaluation in excess of 20 percent from October 25, 2010 for right upper extremity loss of strength and sensation associated with multiple sclerosis is remanded. Entitlement to an initial evaluation in excess of 10 percent prior to August 7, 2013, 20 percent from August 7, 2013 to March 9, 2015, 40 percent from March 9, 2005 to April 20, 2018, and 60 percent from April 20, 2018, for a bladder disability associated with multiple sclerosis is remanded. Entitlement to an initial compensable evaluation prior to April 20, 2008 and in excess of 30 percent from April 20, 2018, for bowel functional impairment associated with multiple sclerosis is remanded. Entitlement to an initial compensable evaluation prior to February 13, 2010 and in excess of 10 percent thereafter, for right eye optic neuritis with diplopia associated with multiple sclerosis is remanded. Entitlement to an initial evaluation in excess of 10 percent from September 19, 2011, for a cervical spine disability associated with multiple sclerosis is remanded. Entitlement to an initial compensable evaluation for swallowing difficulties associated with multiple sclerosis is remanded. Entitlement to an evaluation in excess of 70 percent for posttraumatic stress disorder (PTSD) is remanded. Entitlement to an evaluation in excess of 10 percent from February 25, 2016 to April 5, 2019 and 20 percent from April 5, 2019, for a lumbar spine disability is remanded. Entitlement to SMC based on a need for the regular aid and attendance of another person is remanded. FINDINGS OF FACT 1. A claim of service connection for a bladder disability associated with multiple sclerosis was received on March 24, 2009; there is no evidence of any unadjudicated formal or informal claim of service connection for a bladder disability associated with multiple sclerosis prior to that date. 2. The Veteran's claim of service connection for a right eye disability was originally denied in an April 2006 rating; the Veteran did not appeal this decision within one year of its issuance and new and material evidence was not received within that year. 3. The evidence is at least evenly balanced as to whether the application to reopen the claim of service connection for an eye disability secondary to multiple sclerosis was made on September 21, 2007 when she filed a claim of service connection for multiple sclerosis. 4. An informal claim of service connection for a bowel disability associated with multiple sclerosis was received on October 25, 2010 when a VA examination was conducted; there is no evidence of any unadjudicated formal or informal claim of service connection for a bowel disability associated with multiple sclerosis prior to that date. 5. A claim of service connection for a cervical spine disability associated with multiple sclerosis was received on September 19, 2011; there is no evidence of any unadjudicated formal or informal claim of service connection for a cervical spine disability associated with multiple sclerosis prior to that date. 6. The effective date of the grant of service connection for multiple sclerosis is September 21, 2007, and service connection for left upper extremity disability was awarded secondary to multiple sclerosis. 7. A complaint and finding of swallowing difficulties were made for the first time in the medical evidence at a VA examination conducted on March 9, 2015. 8. A complaint of right upper extremity has been associated with the 2010 flare of the Veteran's multiple sclerosis, and the evidence is at least evenly balanced as to whether a treatment record dated February 12, 2010 determined that the right upper extremity disability was associated with multiple sclerosis. CONCLUSIONS OF LAW 1. The criteria for an effective date prior to March 24, 2009 for the award of service connection for a bladder disability associated with multiple sclerosis have not been met. 38 U.S.C. §§ 5110 (a); 38 C.F.R. §§ 3.155 (in effect prior to March 24, 2015), 3.400. 2. With resolution of reasonable doubt in the Veteran's favor, the criteria for an effective date of September 21, 2007, but not earlier, for the award of service connection for right eye optic neuritis with diplopia associated with multiple sclerosis have been met. 38 U.S.C. §§ 5110 (a); 38 C.F.R. §§ 3.155 (in effect prior to March 24, 2015), 3.400. 3. The criteria for an effective date prior to March 24, 2009 for the award of service connection for a bowel disability associated with multiple sclerosis have not been met. 38 U.S.C. §§ 5110 (a); 38 C.F.R. §§ 3.155 (in effect prior to March 24, 2015), 3.400. 4. The criteria for an effective date prior to September 19, 2011 for the award of service connection for a cervical spine disability associated with multiple sclerosis have not been met. 38 U.S.C. §§ 5110 (a); 38 C.F.R. §§ 3.155 (in effect prior to March 24, 2015), 3.400. 5. The criteria for an effective date prior to September 21, 2007 for the award of service connection for a left upper extremity disability associated with multiple sclerosis have not been met. 38 U.S.C. §§ 5110 (a); 38 C.F.R. §§ 3.155 (in effect prior to March 24, 2015), 3.400. 6. The criteria for an effective date prior to March 9, 2015 for the award of service connection for swallowing difficulties associated with multiple sclerosis have not been met. 38 U.S.C. §§ 5110 (a); 38 C.F.R. §§ 3.155 (in effect prior to March 24, 2015), 3.400. 7. With resolution of reasonable doubt in the Veteran's favor, the criteria for an effective date of February 12, 2010, but not earlier, for the award of service connection for right upper extremity disability associated with multiple sclerosis have been met. 38 U.S.C. §§ 5110 (a); 38 C.F.R. §§ 3.155 (in effect prior to March 24, 2015), 3.400. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from January 2004 to May 2005. This matter originally comes before the Board of Veterans' Appeals (Board) on appeal from Department of Veterans Affairs (VA) Regional Office (RO)'s rating decision issued in June 2009. The Veteran testified before the undersigned Veterans Law Judge during a September 2014 Central Office hearing; a transcript is of record. The Board first remanded the issues of increased rating for multiple sclerosis and TDIU in May 2015. In June 2016, the Board, in pertinent part, assigned a 30 percent rating for multiple sclerosis from March 9, 2015; a 10 percent rating for urinary frequency from March 24, 2009; a 20 percent rating for voiding dysfunction from August 7, 2013; a 10 percent rating for right eye optic neuritis from February 13, 2010; a 10 percent rating for cervical spine disability from June 2, 2014; a 10 percent rating for left upper extremity disability. Additionally, the decision denied a rating higher than 40 percent for voiding dysfunction from March 9, 2015; a compensable rating for constipation; and a compensable rating for swallowing difficulties. The Veteran's motion for reconsideration of this decision was received in July 2016 and denied in November 2019. The Veteran appealed the June 2016 Board decision to the Court of Appeals for Veterans Claims (Court). In a December 2020 memorandum decision, the Court found that remand is warranted based on multiple errors conceded by the Secretary of VA. Accordingly, the Court set aside the negative portions of the June 2016 Board decision without disturbing favorable findings therein and remanded the case for readjudication. Additionally, this initial appeal has been merged with two other appeal streams originating from rating decisions issued in November 2016 and December 2016. A Notice of Disagreement was received in May 2017, followed by issuance of a SearchStatement of the Case (SOC) in August 21, 2019 and August 22, 2019. The appeal was perfected in October 2019 and merged with the original appeal because issues on appeal are related to the initial appeal. The Board notes that in a July 2018 rating decision, the Veteran was awarded service connection for left lower extremity disability associated with multiple sclerosis with an evaluation of 10 percent, effective September 21, 2007 and service connection for right lower extremity disability associated with multiple sclerosis with an evaluation of 10 percent, effective April 20, 2018. This decision was not appealed. In the same July 2018 rating decision, the RO granted a 20 percent evaluation for multiple sclerosis with left upper extremity disability from September 21, 2007. This, as well as any other decisions rendered by the RO on the issues appeal, is reflected in the most recent August 2019 Rating Decision Codesheet. The issues on appeal have been updated to incorporate any change in the ratings that occurred during the pendency of appeal. Effective Date Generally, the effective date of an evaluation and award of pension, compensation or dependency and indemnity compensation based on an original claim, a claim reopened after final disallowance, or a claim for increase will be the date of receipt of the claim or the date entitlement arose, whichever is later. 38 U.S.C. § 5110 (a); 38 C.F.R. § 3.400. VA amended its adjudication regulations on March 24, 2015 to require that all claims governed by VA's adjudication regulations be filed on standard forms prescribed by the Secretary, regardless of the type of claim or posture in which the claim arises. See 79 Fed. Reg. 57660 (Sept. 25, 2014). The amendments, however, are only effective for claims and appeals filed on or after March 24, 2015. As the claims in this case were filed prior to that date or the Veteran contends that they were, the amendments are not applicable in this instance and the regulations in effect prior to March 24, 2015 will be applied in this case. Under the former legal authority, any communication or action, indicating an intent to apply for one or more benefits under laws administered by VA, from a veteran or his representative, may be considered an informal claim. Such informal claim must identify the benefit sought. Upon receipt of an informal claim, if a formal claim has not been filed, an application form will be forwarded to the claimant for execution. If received within one year from the date it was sent to the veteran, it will be considered filed as of the date of receipt of the informal claim. 38 C.F.R. § 3.155 (a) (in effect prior to March 24, 2015). There is no set form that an informal written claim must take. All that is required is that the communication indicates an intent to apply for one or more benefits under the laws administered by VA, and identify the benefits sought. Rodriguez v. West, 189 F.3d 1351 (1999). Moreover, when granting entitlement to service connection for a disability in response to an application to reopen a claim that had previously been denied, VA cannot assign an effective date earlier than the date of receipt of the application to reopen. 38 U.S.C. § 5110 (a); see also 38 C.F.R. § 3.400 (r) (effective date of reopened claim is date of receipt of claim or date entitlement arose, whichever is later); Comer v. Peake, 552 F.3d 1362, 1370 (Fed. Cir. 2009) ("The earliest effective date for an award based on a veteran's request to reopen a final decision based on new and material evidence is generally the date that the application to reopen was filed"). Lastly, as awards of secondary service connection are not awards of increased compensation within the meaning of the statute, the effective date can be no earlier than the date of the claim for service connection on a secondary basis. Ellington v. Nicholson, 22 Vet. App. 141, 145 (2007) (finding that the effective date for a grant of service connection for diabetes and hypertension as secondary to leukemia was the date of the claim for secondary service connection, not the date of the claim of service connection for leukemia), aff'd sub nom. Ellington v. Peake, 541 F.3d 1364 (Fed. Cir. 2008); Ross v. Peake, 21 Vet. App. 528, 532-33 (2008) (holding that the effective date for a grant of secondary service connection for depression with anxiety was the date of the secondary service connection claim, not the date of the claim for service connection for the primary heart condition). 1. Effective date prior to March 24, 2009 for the grant of service connection for a bladder disability associated with multiple sclerosis The Veteran's claim for an effective date prior to March 24, 2009 for the grant of service connection for a bladder disability associated with multiple sclerosis is denied, for the date of claim for the bladder disability is March 24, 2009, with no documentation of record prior to that date which shows an intent to file a claim for the disability. A September 2005 VA examination reports that the Veteran did not have bladder or bowel symptoms. The evidence of record shows that the Veteran's multiple sclerosis manifested with symptoms of blurred vision and diplopia, as well as numbness of the right arm and bilateral leg numbness in around 2006. The diagnosis of multiple sclerosis was confirmed by testing in 2007. A May 2008 VA multiple sclerosis examination reflects a complaint of blurred vision and double vision, disagreeable sensation through her shoulders and arms, numbness on the left side of her body, and slow reaction. No problems with bladder were reported. A January 2009 VA Neurology Note the Veteran had a symptom of bladder dysfunction and reported having flares of urinary overflow incontinence. She was assessed with bladder dysfunction. On March 24, 2009, the Veteran's claim for an increased evaluation for multiple sclerosis was received. In a September 2011 statement, the Veteran reported that she had issues with bladder control due to multiple sclerosis and provided detailed description of bladder and urinary impairment. Accordingly, given the history summarized above, the date of claim for bladder dysfunction that is ascertainable in the evidence is March 24, 2009. The May 2008 VA examination did not reflect that the Veteran had a chronic bladder problem. The Veteran sought treatment for the problem in January 2009, which is the earliest documented onset of the chronic disability of the bladder. There is no document in the claims file that could be construed as informal claim, with an intent to file a claim. Since the effective date for the grant of service connection must be the later of the date of claim or the date entitlement arose, as is the assigned effective date here, the Veteran's claim must be denied. 2. Effective date prior to March 24, 2009 for the grant of service connection for right eye optic neuritis with diplopia associated with multiple sclerosis The Veteran's claim for an earlier effective date for the grant of service connection for right eye disability associated with multiple sclerosis is granted. The evidence is at least as evenly balanced as to whether the claim of service connection for multiple sclerosis is construed as an informal claim of service connection for associated visual disability. The April 2006 rating decision denied the Veteran's claim of service connection for vision problems of the right eye. No notice of disagreement or new and material evidence was received within its appeal period. Thus, the April 2006 rating decision became final. 38 U.S.C. § 7105 (b) (2000, Supp. 2001); 38 C.F.R. §§ 3.104, 20.302, 20.1103 (2005). As noted above, the evidence of record shows that the Veteran's multiple sclerosis manifested with symptoms of blurred vision and diplopia, as well as numbness of the right arm and bilateral leg numbness, in around 2006. The diagnosis of multiple sclerosis was confirmed by testing in August 2007. On September 21, 2007, the Veteran's claim of service connection for multiple sclerosis was received. In a February 2008 rating decision, service connection for multiple sclerosis was granted, effective September 21, 2007, the date of claim. Shortly after, the Veteran underwent a first VA examination for multiple sclerosis on May 13, 2008. The examiner noted the Veteran's blurred vision and double vision and these symptoms were compatible with the demyelinating disease. The evidence, when viewed in the light most favorable to the Veteran, indicates that the Veteran's multiple sclerosis manifested with the symptoms of the eye disability. In fact, the complaint about the vision problems led the clinicians to test for multiple sclerosis. Thus, the claim of service connection for multiple sclerosis, made on September 21, 2007, must be construed as an informal claim for the associated visual disability. As such, an effective date of September 21, 2007, but no earlier, for the grant of service connection for right eye optic neuritis with diplopia associated with multiple sclerosis is granted. 3. Effective date prior to October 25, 2010 for the grant of service connection for bowel functional impairment associated with multiple sclerosis The Veteran's claim for an effective date prior to October 25, 2010 for the grant of service connection for a bowel disability associated with multiple sclerosis is not supported by the evidence of record. A September 2005 VA examination did not reflect a complaint of bladder or bowel symptoms. A January 2009 VA neurology note indicates that the Veteran reported that her bowel movement was regular. An October 25, 2010 VA examination reflects a complaint of history of impairment of bowel function. The examiner did not provide an opinion as to whether this bowel impairment was associated with multiple sclerosis, while other symptoms such as vision problems and numbness and tingling sensation were determined as due to multiple sclerosis. An August 2013 VA examination for multiple sclerosis does not reflect a complaint of the bowel dysfunction. Indeed, the examiner found that the Veteran did not have any bowel functional impairment due to multiple sclerosis. At the same time, an August 2013 letter from VA Medical Center indicates neurogenic bowel and bladder. Thus, the evidence viewed in the most favorable light to the Veteran indicates that the bowel impairment due to multiple sclerosis was first documented in the October 2010 VA examination. Prior to the examination, the evidence does not indicate that the Veteran had the disability. In sum, the October 2010 VA examination can be deemed the date entitlement arose. As no claim of service connection for a bowel disability, to include any communication that could be construed as an intent to file, predates this, and as the later date applies, there is no basis for an earlier effective date. 4. Effective date prior to September 19, 2011 for the grant of service connection for a cervical spine disability associated with multiple sclerosis An effective date prior to September 19, 2011 for the grant of service connection for a cervical spine disability associated with multiple sclerosis is denied. On September 19, 2011, the Veteran's claim of service connection for a cervical spine disability was received. No documents prior to that date show an intent to file a claim of service connection for the disability. Indeed, a June 2014 rating decision granted service connection for the disability effective September 19, 2011. Moreover, no medical records reflect an intent to file a claim and thus there is no medical evidence that would constitute an informal claim under the provisions of 38 C.F.R. § 3.157 as then in effect. Thus, the date of the formal claim is September 19, 2011 with no informal claim associated with the claims file. The Veteran's claim is denied. 5. Effective date prior to September 21, 2007 for the grant of service connection for left upper extremity disability associated with multiple sclerosis The Veteran's claim for an effective date prior to September 21, 2007 for the grant of service connection for left upper extremity disability associated with multiple sclerosis is denied. Service connection for left upper extremity loss of strength and sensation has been granted effective September 21, 2007. Upon May 2008 VA examination, the Veteran reported that "[f]or the past month, she has noted numbness on the left side of her body ... the arm is more prominently involved than the leg." This is the earliest reference in the record to neurologic manifestations of the left upper extremity. Thus, there is no basis for an earlier effective date. Indeed, no claim pre-dates September 21, 2007, and there is no showing that entitlement arose prior to that date. 6. Effective date prior to March 9, 2015 for the grant of service connection for swallowing difficulties associated with multiple sclerosis The Veteran's claim for an effective date prior to March 9, 2015 for the grant of service connection for swallowing difficulties associated with multiple sclerosis is not supported by the evidence of record. An October 2010 VA multiple sclerosis examination notes that a history of swallowing difficulty was denied. An August 2013 VA multiple sclerosis examination does not reflect any complaint of swallowing difficulties. The examiner did not find that she had such symptoms. A March 2, 2015 VA neurology note indicates that the Veteran denied swallowing difficulties. A March 9, 2015 VA multiple sclerosis examination reflects a finding of mild swallowing difficulties. Accordingly, the evidence indicates that the date of an informal claim for swallowing difficulties associated with multiple sclerosis cannot be prior to March 9, 2015. The Veteran's claim is therefore denied. 7. Effective date prior to August 16, 2013 for the grant of service connection for right upper extremity disability associated with multiple sclerosis The claim for an effective date of October 25, 2010, but no earlier, for the grant of service connection for right upper extremity disability is warranted because the evidence is at least evenly balanced as to whether October 25, 2010 is the date when the symptom involving right upper extremity was noted to be associated with multiple sclerosis. A May 2008 VA multiple sclerosis examination found that there was no difficulty with the right arm. A May 2009 VA multiple sclerosis examination does not reflect a finding or complaint about right upper extremity functional impairment. Starting from January 2010, VA treatment records report a complaint of the right arm weakness and clumsiness with lack of feeling in the entire arm after a recent flare of multiple sclerosis. An October 25, 2010 VA multiple sclerosis examination reflects a finding of leg numbness. Also, a history of weakness in varying degree was noted in a "single limb to total body," as well as a history of numbness in "extremities." Detailed reflex examination findings reflect absence of reaction in biceps, triceps, and brachioradialis on the right. Sensory examination was normal for the right upper extremity. The examiner noted a result of MRI for cervical spine conducted on February 12, 2010 based on a clinical history of exacerbated multiple sclerosis and right arm clumsiness and weakness. In the comments, the examiner noted that numbness and tingling sensation in the body was likely caused by or a result of her service-connected multiple sclerosis. Resolving doubt in the Veteran's favor, then, the Board finds that entitlement arose as of February 12, 2010. This is the later date compared to the date of claim in September 2007 and the later date applies. 38 C.F.R. § 3.340. REASONS FOR REMAND 1. Service connection for a left shoulder disability The previously denied claim of service connection for a left shoulder disability was reopened in an August 2019 SOC. A June 2014 VA examination reflects no current diagnosis of a left shoulder disability. However, an April 2005 service treatment record reflects her complaint of left shoulder pain, and a May 2008 VA examination for multiple sclerosis reflects the Veteran's complaint that she had disagreeable sensation extending through her shoulder. The Board notes that a diagnosis is not required to meet the current disability requirement and pain alone can constitute disability if it causes impairment in earning capacity. Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018). Upon remand, a new VA examination must be scheduled, and a medical etiology opinion must be obtained. 2. Initial evaluation in excess of 20 percent for multiple sclerosis from September 21, 2007, with a left upper extremity disability 3. Initial evaluation in excess of 20 percent for right upper extremity loss of strength and sensation associated with multiple sclerosis 4. Initial evaluation in excess of 10 percent prior to August 7, 2013, 20 percent from August 7, 2013 to March 9, 2015, 40 percent from March 9, 205 to April 20, 2018, and 60 percent from April 20, 2018, for a bladder disability associated with multiple sclerosis 5. Initial compensable evaluation prior to April 20, 208 and in excess of 30 percent from April 20, 2018, for bowel functional impairment associated with multiple sclerosis 6. Initial compensable evaluation from September 21, 2007 prior to February 13, 2010 and in excess of 10 percent thereafter, for right eye optic neuritis with diplopia associated with multiple sclerosis 7. Initial evaluation in excess of 10 percent from September 19, 2011, for a cervical spine disability associated with multiple sclerosis 8. Initial compensable evaluation from March 9, 2015, for swallowing difficulties associated with multiple sclerosis 9. Evaluation in excess of 70 percent for PTSD 10. Evaluation in excess of 10 percent from February 25, 2016 to April 5, 2019 and 20 percent from April 5, 2019, for a lumbar spine disability 11. SMC based on a need for the regular aid and attendance of another person For all the increased rating claims, remand is necessary for rating purposes because a contemporary VA examination must be scheduled for each disability and VA treatment records must be obtained. For multiple sclerosis, lumbar spine disability, and PTSD, the most recent examination was conducted in June 2018. For the eye disability, the last examination was conducted in October 2016. More recent examinations must be obtained in order to adjudicate the Veteran's claim fully. See 38 C.F.R. §§ 3.326, 3.327; Snuffer v. Gober, 10 Vet. App. 400, 403 (1997). Moreover, no VA treatment records have been associated with the claims file since August 2019. 38 C.F.R. § 3.159(c)(3). Thus, upon remand, a VA examination must be scheduled to ascertain the current severity of the Veteran's claimed disabilities, and outstanding VA treatment records must be obtained. The Board notes that as of September 21, 2007, the Veteran is in receipt of service connection for multiple sclerosis, left upper extremity, due to multiple sclerosis, and the eye disability due to multiple sclerosis, and claims on appeal include an initial evaluation for left upper extremity disability and eye disability. When readjudicating the claims, this must be taken into account and proper rating must be assigned in accordance with Diagnostic Code 8018 under 38 C.F.R. § 4.124a. The matters are REMANDED for the following action: 1. Obtain the Veteran's VA treatment records for the period from September 2018 to the Present. 2. Schedule the Veteran for a VA examination for her left shoulder disability. The examiner must review the claims file. If a diagnosis cannot be provided but the Veteran's condition manifests in symptoms that cause functional impairment, then the examiner should consider them a "disability" for the purpose of providing the requested opinion(s) below. The examiner should provide an opinion as to (1) whether the Veteran's left shoulder disability had causal origins in service or is otherwise related to the Veteran's active duty service; and (2) whether the left shoulder disability was (A) caused or (B) aggravated beyond its normal progression by her service-connected multiple sclerosis. If aggravation is found, the examiner should attempt to identify the baseline level of disability prior to such aggravation 3. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of her service-connected multiple sclerosis and associated disabilities, to include eye disability, bladder disability, bowel disability, bilateral upper extremity disability, cervical spine disability, and swallowing disability. For each disability, the examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's disability under the rating criteria. For cervical spine disability, the examiner must attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. 4. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of her service-connected PTSD. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's disability under the rating criteria. The examiner must attempt to elicit information regarding the severity, frequency, and duration of symptoms. To the extent possible, the examiner should identify any symptoms and social and occupational impairment due to her PTSD alone. 5. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of her service-connected lumbar spine disability. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's disability under the rating criteria. In so doing, the examiner must attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. 6. Schedule the Veteran for an examination by an appropriate clinician to determine the extent of a need for regular aid and attendance of another person due to her service-connected disabilities. The examiner should provide a full description of the Veteran's need in aid and attendance due to her service-connected disabilities from a medical perspective. (Continued on the next page) 7. Readjudicate the claims. While doing so, it must be noted that as of September 21, 2007, the Veteran is in receipt of service connection for multiple sclerosis, left upper extremity due to multiple sclerosis, and the eye disability due to multiple sclerosis, and claims on appeal include an initial evaluation for left upper extremity disability and eye disability. A proper rating for each disability must be assigned in accordance with applicable Diagnostic Codes and Diagnostic Code 8018 for multiple sclerosis under 38 C.F.R. § 4.124a. Eric S. Leboff Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Y. Taylor 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.