HIP IMPAIRMENT OF

PAULETTE VANCE BURTON · 2026 · Case ID: 26005099

MIXED

Summary

The Veteran, who served in the U.S. Navy from September 1972 to May 1976, and passed away in November 2017, had claims for hip replacements, liver conditions, and radiculopathy before the Board. The appellant, his surviving spouse, sought higher ratings for bilateral hip replacements and service connection for liver conditions and radiculopathy. The Board denied increased ratings for bilateral hip replacements, finding the Veteran's residuals of weakness, pain, or limitation of motion did not meet the criteria for higher evaluations, noting pain levels were mild and not indicative of severe impairment. Service connection for non-alcoholic steatohepatitis and cirrhosis of the liver was granted, based on a VA examiner's opinion that these conditions were aggravated by the Veteran's service-connected bilateral hip replacements, with obesity as an intermediate step, resolving doubt in the Veteran's favor. Claims for bilateral upper and lower extremity radiculopathy were denied, as the Board found the weight of the evidence, including multiple VA examinations and an EMG study, indicated neuropathy rather than radiculopathy, despite one physical therapy record suggesting otherwise. The Board remanded claims for increased ratings for cervical and lumbosacral strains, requiring further VA medical opinions to clarify the ameliorative effects of medication and to estimate functional loss during pain flare-ups.

Rationale

Residuals did not meet criteria for higher rating; Pain levels (2/10-3/10) not considered severe; Range of motion not significantly limited

Service Branch

NAVY

Special Benefit

NO SPECIAL BENEFIT

Diagnostic Code

5054

Docket No.

16-27 538

Full Decision Text

Citation Nr: 26005099
Decision Date: 04/30/26 Archive Date: 04/30/26

DOCKET NO. 16-27 538
DATE: April 30, 2026

ORDER

Entitlement to an evaluation of more than 30 percent for right hip replacement is denied.

Entitlement to an evaluation of more than 30 percent for left hip replacement is denied.

Entitlement to service connection for non-alcoholic steatohepatitis and cirrhosis of the liver is granted.

Entitlement to service connection for right upper extremity radiculopathy is denied.

Entitlement to service connection for left upper extremity radiculopathy is denied.

Entitlement to service connection for right lower extremity radiculopathy is denied.

Entitlement to service connection for left lower extremity radiculopathy is denied.

REMANDED

Entitlement to an evaluation of more than 20 percent for a cervical strain is remanded.

Entitlement to an evaluation of more than 20 percent for a lumbosacral strain is remanded.

FINDINGS OF FACT

1. For the entire period on appeal, the Veteran's right hip replacement is not shown to have manifested by moderately severe, or markedly severe, weakness, pain, or limitation of motion following implantation of prothesis; requiring the use of crutches is not shown.

2. For the entire period on appeal, the Veteran's left hip replacement is not shown to have manifested by moderately severe, or markedly severe, weakness, pain, or limitation of motion following implantation of prothesis; requiring the use of crutches is not shown.

3. The Veteran is shown to have had non-alcoholic steatohepatitis and cirrhosis of the liver that was aggravated by service-connected disability, with obesity as an intermediate step.

4. The Veteran is not shown to have had a current right upper extremity radiculopathy disability.

5. The Veteran is not shown to have had a current left upper extremity radiculopathy disability.

6. The Veteran is not shown to have had a current right lower extremity radiculopathy disability.

7. The Veteran is not shown to have had a current left lower extremity radiculopathy disability.

CONCLUSIONS OF LAW

1. The criteria for entitlement to an evaluation of more than 30 percent for right hip replacement have not been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5054.

2. The criteria for entitlement to an evaluation of more than 30 percent for left hip replacement have not been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5054.

3. The criteria for entitlement to service connection for non-alcoholic steatohepatitis and cirrhosis of the liver have been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310.

4. The criteria for entitlement to service connection for right upper extremity radiculopathy have not been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310.

5. The criteria for entitlement to service connection for left upper extremity radiculopathy have not been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310.

6. The criteria for entitlement to service connection for right lower extremity radiculopathy have not been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310.

7. The criteria for entitlement to service connection for left lower extremity radiculopathy have not been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the
for right lower extremity radiculopathy have not been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310.

7. The criteria for entitlement to service connection for left lower extremity radiculopathy have not been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Navy from September 1972 to May 1976. The Veteran died in November 2017. The appellant is his surviving spouse and has been substituted as the claimant. See 38 U.S.C. § 5121A.

These matters come before the Board of Veterans' Appeals (Board) on appeal from August 2015 and June 2017 rating decisions by the Regional Office (RO).

In January 2020, the appellant withdrew the request for a Board hearing. In May 2020 and December 2021, September 2023, and May 2024, the Board remanded the claims for further development. Such development has been completed and associated with the claims file, and these matters are now returned to the Board for decision.

1. Entitlement to an evaluation of more than 30 percent for right hip replacement is denied.

2. Entitlement to an evaluation of more than 30 percent for left hip replacement is denied.

An August 2015 rating decision granted service connection for right and left hip replacements and assigned 30 percent ratings under Diagnostic Code 5054, effective March 30, 2015. The appellant, as the substituted claimant, seeks higher initial ratings. See NOD, September 2015.

Diagnostic Code 5054, hip, resurfacing or replacement (prosthesis), provides for a 100 percent rating for four months following implantation of prosthesis or resurfacing. Thereafter, a 30 percent rating is provided for as the minimum evaluation, total replacement only. A 50 percent rating is provided for moderately severe residuals of weakness, pain, or limitation of motion. A 70 percent rating is provided for markedly severe residual weakness, pain, or limitation of motion following implantation of prosthesis. A 90 percent rating is provided following implantation of prothesis with painful motion or weakness such as to require the use of crutches. 38 C.F.R. § 4.71a.

Although several of the musculoskeletal rating criteria were amended, effective February 7, 2021, the rating criteria under Diagnostic Code 5054 are effectively unchanged insofar as the code applies to this particular decision. While the amendment changed the period for a temporary 100 percent rating following implantation of prothesis from one year to four months, this change is irrelevant in this case because the replacement surgeries occurred 25 years ago.

The Board acknowledges that the terms "moderately severe" and "markedly severe" for purposes of the 50 percent and 70 percent rating criteria are not defined in the rating schedule. Rather than applying a mechanical formula, VA must evaluate all the evidence to the end that its decisions are "equitable and just." 38 C.F.R. § 4.6. Nonetheless, the Board is mindful that "severe" is defined as "very bad, serious, or unpleasant," or "causing a lot of physical pain or suffering." See Brittanica Dictionary (https://www.britannica.com/ dictionary/severe, accessed 3/12/25).

By way of background, July 2001 and November 2001 VA operative reports show the Veteran underwent a left and right hip total arthroplasties (replacements). See Records, November 2003 at p.27 and 62 of 82.

A May 2016 VA examination report shows the Veteran reported experiencing outer hip pain of 2/10 to 3/10, which he described as feeling like Charlie horses at times. The examiner noted that the Veteran reported no other problems with the hips. Examination of both hips revealed flexion to 90 degrees (of 125), extension to 10 degrees (of 30), abduction to 30 degrees (of 45), and adduction to 20 degrees (of 25). External and internal rotation were not tested due to concerns based on the hip implants. No pain with weight bearing was found. The examiner noted that functional ability was not significantly limited with repeated use over time. No flare-ups were reported. Muscle strength was 5/5, no ankylosis was found, and no malunion or nonunion of femur, flail hip joint, or leg length discrepancy. The examiner did not find residuals of weakness or requiring the use of crutches. The examiner opined that the hip conditions did not affect the Veteran's ability to work.

The Board has carefully reviewed all of the other medical evidence of record, which does not show symptoms more severe than found on examination.

The Board finds that the weight of the evidence is most persuasively against finding that the Veteran's right and left hip replacement disabilities (each) meet or more nearly approximate the criteria for the next higher 50 percent rating under old and current Diagnostic Code 5054. The Board finds that "moderately severe" residuals of weakness, pain, or limitation of motion are not shown. As noted above, the term "severe" is defined as "very bad, serious, or unpleasant," or "causing a lot of physical pain or suffering." The Board finds that pain of 2/10 to 3/10 is not consistent, and less severe than, "very bad, serious, or unpleasant" or "causing a lot of physical pain or suffering." In fact, it is less than halfway on the scale from one to 10. Ranges of motion were overall not significantly limited. No weakness is shown. None of his treatment records characterize the hip disability as severe. Therefore, the Board finds that the criteria for a higher rating as moderately severe or markedly severe have not been met or approximated.

In this case, the appellant has not contended, and the evidence does not suggest, that the Veteran experienced symptoms outside of those listed in the schedular criteria. See Doucette v. Shulkin, 28 Vet. App. 366 (2017) (Board is not obligated to analyze whether referral for extraschedular consideration is warranted if 38 C.F.R. § 3.321(b)(1) is neither specifically sought by the claimant nor reasonably raised by the facts found by the Board).

Accordingly, the Board concludes that the weight of the evidence is most persuasively against finding entitlement to an evaluation of more than 30 percent for the Veteran's right and left hip replacement disabilities (each), and the claims are denied. Because there is not an approximate balance of positive and negative evidence, the benefit of the doubt rule is not for application. See 38 U.S.C. § 5107(b); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

3. Entitlement to service connection for cirrhosis of the liver, residual of non-alcoholic steatohepatitis, is granted.

The appellant seeks entitlement to service connection for the Veteran's non-alcoholic steatohepatitis and cirrhosis of the liver. See Form 21-526EZ, May 2017; Brief, January 2025.

"Obesity may be an 'intermediate step' between a service-connected disability and a current disability that may be service connected on a secondary basis." Garner v. Tran, 33 Vet. App. 241, 247 (2021) (quoting VA Gen. Couns. Prec. 1-2017). "Obesity, although itself not a disability for which compensation may be awarded, can constitute an 'intermediate step' in demonstrating service connection on a secondary basis for another condition." Walsh v. Wilkie, 32 Vet. App. 300, 302 (2020) (involving whether secondary service connection for sleep apnea was warranted based on a theory that obesity, as an intermediate step, was aggravated by service-connected disability). Obesity must, of course, first be shown to be caused by or aggravated by a service-connected condition. Id. at 304.

An August 2001 VA treatment record shows the Veteran was six feet tall, weighed 295 pounds, his BMI
. 1-2017). "Obesity, although itself not a disability for which compensation may be awarded, can constitute an 'intermediate step' in demonstrating service connection on a secondary basis for another condition." Walsh v. Wilkie, 32 Vet. App. 300, 302 (2020) (involving whether secondary service connection for sleep apnea was warranted based on a theory that obesity, as an intermediate step, was aggravated by service-connected disability). Obesity must, of course, first be shown to be caused by or aggravated by a service-connected condition. Id. at 304.

An August 2001 VA treatment record shows the Veteran was six feet tall, weighed 295 pounds, his BMI was 40, and fatty liver disease was diagnosed by ultrasound. See CAPRI, November 2024 at p.2813 of 2853. A July 2004 VA liver ultrasound again found fatty liver disease. See id. at p.2682. A May 2010 VA treatment record shows the Veteran weighed 317 pounds, with a BMI of 43, and obesity was noted. See id. at p.1733. A liver ultrasound revealed fatty infiltration and hepatosplenomegaly, non-alcoholic steatohepatitis was noted in the treatment record, and the Veteran was advised to lose weight and more tightly control his lipids and glucose levels. See id. at p.1741.

A December 2023 VA examiner opined the Veteran's liver disease, including his nonalcoholic steatohepatitis and liver cirrhosis, were at least as likely as not aggravated by his service-connected bilateral hip replacement disabilities. The examiner reasoned that the hip replacements lowered the Veteran's weight-bearing tolerance and contributed to his weight gain, which weight gain contributed to both diabetes and nonalcoholic steatohepatitis, which steatohepatitis led to cirrhosis.

This VA medical opinion is somewhat similar to a July 2022 VA medical opinion in which this examiner opined that the Veteran's non-alcoholic steatohepatitis and cirrhosis of the liver were caused by diabetes mellitus, which diabetes was in turn caused by his morbidly high BMI and obesity. This examiner opined, however, that the bilateral hip replacement did not contribute to the Veteran's weight gain. The Board also notes that the Veteran is not service connected for diabetes mellitus.

Therefore, as there are two conflicting VA medical opinions, the Board will resolve all doubt in the Veteran's favor, and the Board finds that the Veteran's non-alcoholic steatohepatitis and cirrhosis were aggravated by his service-connected bilateral hip replacements, with obesity as an intermediate step, as opined by the December 2023 VA examiner. The Board notes that this opinion is consistent with the contemporaneous medical evidence of record that shows the Veteran was initially diagnosed with fatty liver disease and weight loss was recommended.

The Board acknowledges that a June 2021 VA medical examiner opined that the liver condition was less likely as not related to the Veteran's active service, to include alleged herbicide exposure, reasoning there was no evidence of liver disease in service, and there is no sufficient objective evidence in medical literature to confirm the type of causativeness. The July 2022 VA examiner similarly opined that the claimed liver conditions were less likely than not related to service, reasoning that they were caused by diabetes mellitus, which in turn was caused by weight gain. However, for the reasons explained above, the Board finds that service connection is nonetheless warranted on a secondary basis.

Accordingly, the Board concludes that entitlement to service connection for non-alcoholic steatohepatitis and cirrhosis of the liver is shown, and the claim is granted.

4. Entitlement to service connection for right upper extremity radiculopathy is denied.

5. Entitlement to service connection for left upper extremity radiculopathy is denied.

6. Entitlement to service connection for right lower extremity radiculopathy is denied.

7. Entitlement to service connection for left lower extremity radiculopathy is denied.

The appellant asserts that the Veteran had bilateral upper extremity radiculopathy secondary to his service-connected cervical strain, and bilateral lower extremity radiculopathy secondary to his service-connected lumbosacral strain. See Form 21-526, May 2017.

A July 2011 EMG report shows diffuse neuropathy was found, as well as left ulnar mononeuropathy, but the report states "I could not find evidence for a radiculopathy on this study." See CAPRI, September 2023 at p.819 of 1778.

A July 2011 VA primary care telephone encounter
Entitlement to service connection for left lower extremity radiculopathy is denied.

A July 2011 VA primary care telephone encounter note shows the Veteran was notified that the EMG/NCV results were consistent with diffuse neuropathy and left ulnar neuropathy, "but no evidence of a radiculopathy" was found. See CAPRI, September 2023 at p.945 of 1778.

An April 2012 VA examination report (back and neck) shows the Veteran's medication list included metformin for diabetes, and gabapentin for neuropathic pain. Examination of the upper and lower extremities revealed muscle strength was 5/5, deep tendon reflexes were 2+, normal sensation was found in the upper extremities, and decreased sensation was found in the lower extremities. The examiner noted that the July 2011 EMG was consistent with axonal neuropathy and ulnar neuropathy. No radiculopathy was diagnosed.

An August 2015 VA examination report (neck), with respect to the upper extremities, shows muscle strength was 5/5, deep tendon reflexes were 2+, and sensory examination to light touch was normal. The examiner opined that the Veteran did not have signs or symptoms of radiculopathy, and no radiculopathy was diagnosed.

An August 2015 VA examination report (back), with respect to the lower extremities, shows muscle strength was 5/5, deep tendon reflexes were 2+, light touch sensation was normal, and straight leg testing was negative. The examiner opined that the Veteran did not have signs or symptoms of radiculopathy, and no radiculopathy was diagnosed.

A May 2016 VA examination report (neck) shows the Veteran reported constant pain in his neck that goes down his arms. With respect to the upper extremities, muscle strength was 5/5, deep tendon reflexes were 0, and light touch sensation was normal. The examiner opined that the Veteran does not have signs or symptoms of radiculopathy, and no radiculopathy was diagnosed.

A May 2016 VA examination report (back) shows the Veteran reported his back pain goes down his legs. The examiner noted "also has a peripheral neuropathy with numbness in toes as a result." He reported bowel incontinence, and that he had mentioned the bowel incontinence previously to clinicians, but the examiner noted a review of the records showed he did not report bowel incontinence at a gastroenterology appointment in March 2015, and an April 2015 primary care record noted normal bowel habits. With respect to the lower extremities, muscle strength was 5/5, deep tendon reflexes were 0, light touch sensation was normal, and straight leg testing was negative. The examiner opined that the Veteran does not have signs or symptoms of radiculopathy, and no radiculopathy was diagnosed.

An October 2016 VA examination report (neck) shows the Veteran reported his neck pain radiated down his back with neck movements. With respect to the upper extremities, muscle strength was 5/5, deep tendon reflexes were 0, and light touch sensation was normal. The examiner opined that the Veteran does not have signs or symptoms of radiculopathy, and no radiculopathy was diagnosed.

An October 2016 VA examination report (back) shows the Veteran reported constant back pain without radiation. With respect to the lower extremities, muscle strength was 5/5, deep tendon reflexes were 0, light touch sensation was normal, and straight leg testing was negative. The examiner opined that the Veteran does not have signs or symptoms of radiculopathy, and no radiculopathy was diagnosed.

A June 2017 VA examination report (peripheral neuropathy) shows the examiner noted peripheral nerve symptoms of moderate or severe constant pain, paresthesias and/or dysesthesias, and numbness in all four extremities. Tingling in the arms and hands was also noted, as well as the Veteran's report of the right lower extremity feeling as if it
back pain without radiation. With respect to the lower extremities, muscle strength was 5/5, deep tendon reflexes were 0, light touch sensation was normal, and straight leg testing was negative. The examiner opined that the Veteran does not have signs or symptoms of radiculopathy, and no radiculopathy was diagnosed.

A June 2017 VA examination report (peripheral neuropathy) shows the examiner noted peripheral nerve symptoms of moderate or severe constant pain, paresthesias and/or dysesthesias, and numbness in all four extremities. Tingling in the arms and hands was also noted, as well as the Veteran's report of the right lower extremity feeling as if it is "on fire," and the left lower extremity experiencing Charlie horses. Deep tendon reflexes were 0 in all four extremities, and light touch sensation was decreased or absent in all four extremities. Trophic changes (loss of hair) were seen on the lower extremities. The examiner opined the Veteran did not have radicular pain or any other signs or symptoms due to radiculopathy. Rather, the examiner noted the Veteran had diabetic peripheral neuropathy.

The Veteran's VA treatment records during the period on appeal show diagnosed uncontrolled diabetes and diabetic peripheral neuropathy. See CAPRI, November 27, 2024 at p.4897 of 5111.

The Board finds the greater weight of the evidence is most persuasively against finding that the Veteran has a radiculopathy disability of either of the upper and lower extremities. As shown above, the July 2011 EMG report shows diffuse neuropathy and left ulnar mononeuropathy was found, but "could not find evidence for a radiculopathy on this study." His primary care clinician notified him after the EMG that there was no evidence of radiculopathy in the EMG study. The April 2012 VA examiner opined the Veteran had axonal neuropathy and ulnar neuropathy rather than radiculopathy. The VA examiners in August 2015, May 2016, October 2016, and June 2017 VA examiners all opined that the Veteran had no signs or symptoms of radiculopathy. The June 2017 VA examiner noted that the Veteran had diabetic neuropathy, which is consistent with the medical evidence showing the Veteran had diagnosed diabetes and diabetic neuropathy and was prescribed gabapentin for "neuropathy" rather than radiculopathy.

The threshold requirement for service connection to be granted is competent evidence of the current existence of a claimed disorder. See Degmetich v. Brown, 104 F.3d 1328 (1997); Brammer v. Derwinski, 3 Vet. App. 223 (1992). Without a current radiculopathy disorder in any of the four extremities, the claims for service connection for bilateral upper and lower extremity radiculopathy as secondary to service-connected cervical and lumbar disabilities cannot be granted. See id.

The Board acknowledges the Veteran's assertion, and later his appellant's assertion as his surviving spouse, that he does in fact have radiculopathy. The Veteran is not shown, however, to be competent to establish the presence of a radiculopathy condition, which requires medical expertise. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007).

The Board also acknowledges that one January 2012 physical therapy record shows diagnosed left upper extremity radiculopathy. See CAPRI, September 2023 at p.819 of 1778. The physical therapist did not, however, address the results of the recent EMG study. The Board finds the EMG test results are by far more probative based on the level of detail in that report. Regardless, the Board finds that the weight of this one PT record is clearly outweighed by the overwhelming majority of all the other medical evidence discussed above showing the Veteran had neuropathy rather than radiculopathy.

Accordingly, as right and left upper extremity radiculopathy, and right and left lower extremity radiculopathy, are not shown, the Board concludes that entitlement to service connection for bilateral upper and lower extremity radiculopathy is not warranted, and the claims are denied. As the weight of the evidence is most persuasively against the claims, the benefit of the doubt rule is not for application. See 38 U.S.C. § 5107(b); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

REASONS FOR REMAND

1. Entitlement to an
the Veteran had neuropathy rather than radiculopathy.

REASONS FOR REMAND

1. Entitlement to an evaluation of more than 20 percent for a cervical strain is remanded.

2. Entitlement to an evaluation of more than 20 percent for a lumbosacral strain is remanded.

The Veteran's cervical strain was assigned a 20 percent rating under Diagnostic Code 5237 from May 7, 1992 (and noncompensable prior to). His lumbosacral strain was assigned a 10 percent rating from May 7, 1992, and 20 percent from March 30, 2015. The appellant, as the substituted claimant, seeks increased ratings. See Form 21-526b, March 2015.

An August 2015 VA examination report relating to the cervical strain shows the Veteran reported taking Tramadol for treatment. The Court of Appeals for Veterans Claims (Court) held in Jones v. Shinseki, and more recently in Ingram v. Collins, that the ameliorative effects of medication should be discounted in rating certain disabilities when medication use is not explicitly contemplated by the relevant rating criteria. See Ingram v. Collins, 38 Vet. App. 130 (2025); Jones v. Shinseki, 26 Vet. App. 56 (2012). The Veteran's cervical strain is rated under the General Rating Formula for Diseases and Injuries of the Spine (Diagnostic Codes 5237-5242), which does not reference medication as a factor in evaluations. See 38 C.F.R. § 4.71a.

Therefore, regrettably, the Board finds that the cervical strain rating claim must be remanded so that a retrospective VA medical opinion may be obtained to address the ameliorative effects of medication, if any, with respect to the findings and conclusions in the August 2015 VA examination report.

In addition, October 2016 VA examinations for the cervical strain and lumbosacral strain show the Veteran reported daily flare-ups of pain, but the VA examiner noted they were unable to opine, without resorting to mere speculation, as to whether there was additional functional limitation due to pain during flare-ups, to include estimating ranges of motion. See Sharp v. Shulkin, 29?Vet. App.?26, 33 (2017). Therefore, regrettably, the Board finds these matters should be remanded so that retrospective VA examinations may be obtained to estimate the Veteran's functional loss during flare-ups, including estimating ranges of motion, with respect to the October 2016 VA examination reports for the cervical and lumbosacral disabilities.

The matters are REMANDED for the following action:

Obtain a retrospective VA medical opinion to (1) clarify the ameliorative effects of medication, if any, with respect to the symptoms and severity of the Veteran's cervical strain disability shown in the August 2015 VA examination report; and (2) estimate functional loss due to pain during flare-ups, including estimating limitation of motion during flare-ups, with respect to the October 2016 VA examination reports for the cervical strain and lumbosacral strain disabilities. The claims file should be made available for review by the examiner, including a copy of this remand. A complete rationale for any opinions expressed should be provided.

To avoid further remand, regarding flare-ups, if additional functional loss cannot be described in terms of degrees of limitation of motion, it should be clear that an examiner has "considered all procurable and assembled data before stating that an opinion cannot be reached," and "that the inability to provide an opinion without resorting to speculation reflects the limitation of knowledge in the medical community at large." The Board may "accept a VA examiner's statement that he or she cannot offer an opinion without resorting to speculation, but only after determining that this is not based on the absence of procurable information or on a particular examiner's shortcomings or general aversion to offering an opinion on issues not directly observed." See Sharp v. Shulkin, 29?Vet. App.?26, 33 (2017).

Paulette

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