CERVICAL SPINE LIMITATION OF MOTION

L. STEPANICK · 2026 · Case ID: A26031683

MIXED

Summary

The veteran, who served honorably in the U.S. Army from June 2006 to November 2007, including service in Southwest Asia and earning the Combat Infantry Badge, appeals rating decisions concerning his cervical spine, right knee, IBS, lumbar spine, and bilateral lower extremity radiculopathy claims. The Board granted service connection for a cervical spine disability, finding it secondary to his service-connected lumbar spine disability based on a private physician's opinion and the benefit of the doubt doctrine. Service connection for a right knee disability was also granted, with the Board finding the evidence in relative equipoise and applying the benefit of the doubt, supported by service treatment records and a private physician's opinion linking the current condition to an in-service injury. Service connection for IBS was granted presumptively, as the veteran is a Persian Gulf veteran with a qualifying chronic disability (chronic diarrhea) that became manifest during service, supported by his statements and a private physician's report, despite a negative VA opinion. The Board remanded claims for increased ratings for the lumbar spine disability and bilateral lower extremity radiculopathy due to inadequate VA examinations, which failed to consider medication effects and provide sufficient rationale for functional impairment and range of motion limitations.

Rationale

Evidence in relative equipoise; Benefit of the doubt applied; Private physician opinion found probative

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

200907-108585

Full Decision Text

Citation Nr: A26031683
Decision Date: 04/07/26 Archive Date: 04/07/26

DOCKET NO. 200907-108585
DATE: April 7, 2026

ORDER

Service connection for a cervical spine disability is granted.

Service connection for a right knee disability is granted.

Service connection for irritable bowel syndrome (IBS) is granted.

REMANDED

Entitlement to a rating in excess of 20 percent for the service-connected lumbar spine disability is remanded.

Entitlement to an initial rating in excess of 10 percent for the service-connected right lower extremity radiculopathy is remanded.

Entitlement to an initial rating in excess of 10 percent for the service-connected left lower extremity radiculopathy is remanded.

FINDINGS OF FACT

1. The Veteran has a current diagnosis of a cervical spine disability, and the evidence is at least in relative equipoise regarding whether such disability is causally related to his active military service.

2. The Veteran has a current diagnosis of a right knee disability, and the evidence is at least in relative equipoise regarding whether such disability is causally related to his active military service.

3. The Veteran is a Persian Gulf Veteran.

4. The Veteran has a current diagnosis of IBS which constitutes a functional gastrointestinal disorder and became manifest during active military service in the Southwest Asia theater of operations.

CONCLUSIONS OF LAW

1. Resolving all reasonable doubt in favor of the Veteran, the criteria for service connection for a cervical spine disability have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

2. Resolving all reasonable doubt in favor of the Veteran, the criteria for service connection for a right knee disability have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

3. Resolving all reasonable doubt in favor of the Veteran, the criteria for service connection for IBS associated with his service in the Persian Gulf War have been met. 38 U.S.C. §§ 1110, 1117, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.317.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served honorably in the United States Army from June 2006 to November 2007, including service in Southwest Asia, for which he was awarded the Combat Infantry Badge, among other decorations.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from rating decisions issued by a Department of Veterans Affairs (VA) Agency of Original Jurisdiction (AOJ) in September 2019 (the "September 2019 Rating Decision") and in October 2019 (the "October 2019 Rating Decision").

In September 2020, the Veteran submitted a Decision Review Request: Board Appeal, (Notice of Disagreement), VA Form 10182, and elected the Hearing docket (the "September 2020 NOD"). On February 8, 2024, the Veteran withdrew his request for a Board hearing (the "February 2024 Hearing Withdrawal").

Therefore, regarding the lumbar spine, cervical spine, right knee, and IBS claims, the Board may only consider (1) the evidence of record at the time of the September 2019 Rating Decision; and (2) any evidence submitted by the Veteran or his representative within ninety (90) days following the February 2024 Hearing Withdrawal. See 38 C.F.R. §?20.302(a). Regarding the bilateral lower extremity radiculopathy claims, the Board may only consider (1) the evidence of record at the time of the October 2019 Rating Decision; and (2) any evidence submitted by the Veteran or his representative within ninety (90) days following the February 2024 Hearing Withdrawal. See id.

If evidence was associated with the claims file during a period of time when additional evidence was not allowed, the Board has not considered it in this decision. See 38 C.F.R. § 20.300. Regarding the issues the Board is remanding, any such evidence will be considered by the AOJ on remand. Regarding the issues the Board is deciding, if the Veteran would like VA to consider any evidence that was added to the claims file that the Board could not consider, the Veteran may file a supplemental claim (VA Form 20-0995) and submit or identify this evidence. See 38 C.F.R. § 3.2501.
4 Hearing Withdrawal. See id.

SERVICE CONNECTION

Service connection is warranted where the evidence of record demonstrates that the veteran suffers from a disability resulting from personal injury suffered or disease contracted in the line of duty or for aggravation of a pre-existing injury suffered or disease contracted in the line of duty during active military service. See 38 U.S.C. § 1110; 38 C.F.R. § 3.303.

Service connection for a disability requires competent and credible evidence of the following: (1) the existence of a current disability; (2) the existence of the disease or injury in service; and (3) a relationship or nexus between the current disability and any injury or disease during service. See Hickson v. West, 12 Vet. App. 247, 252 (1999).

1. Service connection for a cervical spine disability is granted.

The Veteran asserts that his current cervical spine disability is causally related to his active military service, to include his service-connected lumbar spine disability.

After careful review and resolving all reasonable doubt in favor of the Veteran, the Board agrees and finds that the evidence of record is in relative equipoise regarding whether the Veteran's current cervical spine disability is causally related to his service-connected lumbar spine disability.

Establishing service connection on a secondary basis requires evidence sufficient to show that a current disability exists and that the current disability results from the service-connected disability. See 38 U.S.C. § 1110; Spicer v. McDonough, 61 F.4th 1360, 1364 (Fed. Cir. 2023) (holding that section 1110 "requires compensation when a service-connected disease or injury is a but-for cause of a present-day disability"); see also 38 C.F.R. § 3.310.

As an initial matter, in a February 2013 rating decision, the Veteran was awarded service connection for lumbar osteoarthritis and degenerative disc disease (the "lumbar spine disability") and assigned a disability rating of 20 percent, effective January 6, 2012.

In addition, regarding the element of a current diagnosis, in February 2024, the Veteran submitted a February 2021 report authored by a private physician (A.L., D.O.) ("Dr. L.'s February 2021 Report") which states as follows: (1) the Veteran has a diagnosis of cervical sprain/strain; (2) the Veteran reported cervical spine flare-ups, during which he can barely bend the neck forward; and (3) the Veteran's neck pain makes it difficult to do simple things such as reading and driving, due to his inability to turn his neck.

Therefore, the sole remaining question is whether the Veteran's diagnosed cervical spine disability is causally related to his service-connected lumbar spine disability.

Regarding that question, Dr. L.'s February 2021 Report opines that it is at least as likely as not (50 percent or greater probability) that the Veteran's cervical spine disability is proximately due to or the result of the Veteran's service-connected lumbar spine disability, on the following grounds: (1) the Veteran submitted a sworn statement indicating he has progressively shifted and altered his posture when standing, sitting, and walking due to his chronic low back pain, which has resulted in altering his spinal alignment; (2) when the lower part of his spine is tilted, even the slightest bit, his body compensates for such tilt causing his spine to shift; (3) this shift can result in thoracic and cervical pain ultimately disrupting the spinal alignment and giving rise to chronic issues in previously non-disabled spinal segments; and (4) as the record does not contain evidence of any traumatic neck injury, "it is reasonable to conclude" that the Veteran's cervical spine disability "is at least as likely as not due to his service-connected [lumbar spine disability]."

The Board finds that,
has progressively shifted and altered his posture when standing, sitting, and walking due to his chronic low back pain, which has resulted in altering his spinal alignment; (2) when the lower part of his spine is tilted, even the slightest bit, his body compensates for such tilt causing his spine to shift; (3) this shift can result in thoracic and cervical pain ultimately disrupting the spinal alignment and giving rise to chronic issues in previously non-disabled spinal segments; and (4) as the record does not contain evidence of any traumatic neck injury, "it is reasonable to conclude" that the Veteran's cervical spine disability "is at least as likely as not due to his service-connected [lumbar spine disability]."

The Board finds that, in conjunction with the relevant evidence of record, Dr. L.'s February 2021 Report offers probative medical evidence, as it was authored by an expert possessing the necessary education, training, and expertise to provide the requested opinion, it was based upon a review of the Veteran's medical treatment record and current medical history, and it adequately relied upon the relevant lay and medical evidence of record. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008); 38 C.F.R. § 3.159(a)(2). The Board further finds that Dr. L.'s February 2021 Report establishes at least an approximate balance of positive and negative evidence regarding the merits of the issues material to the determination of the Veteran's claim. See Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993).

Accordingly, resolving all reasonable doubt in the Veteran's favor, the Board finds that his cervical spine disability warrants service connection as secondary to his service-connected lumbar spine disability, and the claim is granted. See 38 C.F.R. §§ 3.102, 3.310.

2. Service connection for a right knee disability is granted.

The Veteran asserts that he is entitled to service connection for his current right knee disability that is related to his active military service and which developed as a result of a right knee injury and related pain sustained during his active duty service.

After careful review, and for the reasons set forth below, the Board agrees and finds that service connection for the Veteran's right knee disability is warranted in this case.

As an initial matter, regarding the element of a current diagnosis, Dr. L.'s February 2021 Report states as follows: (1) the Veteran has a current diagnosis of right knee strain; (2) the Veteran sustained a right knee injury during his military service, which has progressively worsened over time in regard to pain, stiffness, and periodic reductions in range of motion; (3) the Veteran suffers from right knee flare-ups, which are usually associated with any periods of weight bearing, such as walking, standing, and using stairs; (4) during flare-ups, the Veteran has "extreme pain" and "severe limitation of motion;" and (5) the Veteran reports right knee pain and restricted motion which results in difficulty ambulating and decreasing his ability to perform activities of daily living.

The Board finds that Dr. L. possesses the necessary education, training, and expertise to diagnosis the Veteran with a cervical spine disability, and therefore, the first element required for the Veteran's service connection claim, a current diagnosis, has been established.

Turning to the second element of an in-service incident, the Veteran's service treatment records dated July 2006 reflect that he was treated for a right knee sprain and related pain during service. In addition, the Veteran reported to Dr. L. that he suffered a right knee injury during service which resulted in "on-going symptoms thereafter that went unreported due to military culture."

The Board finds that the Veteran is competent to describe the circumstances surrounding the onset of the symptoms of his right knee disability, including his in-service activities and his in-service right knee pain, see Layno v. Brown, 6 Vet. App. 465, 469 (1994), as well as the observable and continued symptoms of his right knee disability. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). In addition, the Board finds the lay evidence submitted by the Veteran to be credible, as the statements are consistent with the facts and circumstances of his service as well as with the other evidence of record. See Caluza v. Brown, 7 Vet. App. 498, 511 (1995), aff'd per curiam, 78 F.3d 604 (Fed. Cir. 1996); see also 38 U.S.C. § 1154(a). Accordingly, the Board finds
and continued symptoms of his right knee disability. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). In addition, the Board finds the lay evidence submitted by the Veteran to be credible, as the statements are consistent with the facts and circumstances of his service as well as with the other evidence of record. See Caluza v. Brown, 7 Vet. App. 498, 511 (1995), aff'd per curiam, 78 F.3d 604 (Fed. Cir. 1996); see also 38 U.S.C. § 1154(a). Accordingly, the Board finds the evidence of record to at least be in relative equipoise on this issue, and therefore, affording the Veteran the benefit of the doubt, the second element of the claim, an in-service incident, has also been established.

Finally, turning to the third element of a nexus between the Veteran's current right knee disability and his active military service, the Board finds that this element has also been satisfied. Regarding that issue, Dr. L.'s February 2021 Report opines that it is at least as likely as not that the Veteran's right knee disability was directly incurred during active duty service on the following grounds: (1) the Veteran's July 2006 STRs document his report of right knee pain during military service; (2) the Veteran's current right knee symptoms are consistent with the progression of his in-service right knee issues; (3) the Veteran reported to Dr. L. that he experienced on-going right knee symptoms after his July 2006 treatment that "went unreported due to military culture;" (4) the record contains no evidence "of intercurrent post-service injury" that would otherwise "explain" the Veteran's current right knee disability; and (5) in the absence of such evidence, "it is at least as likely as not that the Veteran's current right knee condition was directly incurred during active duty service, as current symptoms are consistent with progression of in-service issues," and there is no reason to doubt the Veteran's reports.

The Board finds that the positive findings contained in Dr. L.'s February 2021 Report carry significant probative weight, as the opinion was authored by a licensed physician possessing the necessary education, training, and expertise to provide a medical opinion and was based upon accurate factual premises with respect to the Veteran's service and medical history. Moreover, the Veteran's lay statements carry significant probative weight, as they are consistent with other evidence of record regarding the location, type, and circumstances of the Veteran's military service. See 38 U.S.C. § 1154(a); see also Caluza, 7 Vet. App. at 511.

Accordingly, in light of the probative weight of Dr. L.'s February 2021 Report and the Veteran's STRs corroborating the Veteran's in-service right knee treatment, as well as noting his military occupational specialty (MOS) of infantry, the Board finds that the evidence of record addressing whether his current right knee disability arose in service is at least in approximate balance. Therefore, resolving all reasonable doubt in the Veteran's favor, the Board finds that service connection for a right knee disability is warranted, and the claim is granted. See 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 3.303(d).

3. Service connection for IBS is granted.

The Veteran contends that his current IBS is causally related to his active military service in the Southwest Asia theater of operations during the Persian Gulf War. After careful review, and for the reasons set forth below, the Board agrees and finds that service connection for IBS is warranted.

The term "Persian Gulf veteran" means a veteran who served on active military, naval, or air service in the Southwest Asia theater of operations during the Persian Gulf War. See 38 C.F.R. § 3.317(e). The "Southwest Asia theater of operations" refers to Iraq, Kuwait, Saudi Arabia, the neutral zone between Iraq and Saudi Arabia, Bahrain, Qatar, the United Arab Emirates, Oman, the Gulf of Aden, the Gulf of Oman, the Persian Gulf, the Arabian Sea, the Red Sea, and the airspace above these locations. See 38 C.F.R. § 3.317(e).

Persian Gulf veterans may be awarded service connection on a presumptive basis for a "qualifying chronic disability," which includes a chronic disability resulting from any of the following (or any combination of the following): an undiagnosed illness; or a medically unexplained chronic multi-symptom illness (MUCMI) that is defined by a cluster of signs or symptoms, such as chronic fatigue syndrome, fibromyalgia, or functional gastrointestinal disorders. See 38 C.F.R. § 3.317(a)(2)(i). Signs or symptoms which may be manifestations of undiagnosed illness include, but are not limited to, fatigue; signs or symptoms involving skin; headache; muscle pain; joint pain; neurological signs or symptoms; neuropsychological signs or symptoms; signs or symptoms involving the respiratory system (upper or lower); sleep disturbances; gastrointestinal signs or symptoms; cardiovascular signs or symptoms; abnormal weight loss; and menstrual disorders. See 38 C.F.R. § 3.317(b).

The qualifying chronic disability must have become manifest either during active military, naval, or air service in the Southwest Asia theater of operations, or to a degree of 10 percent or more not later than December 31, 2026. See 38 C.F.R. § 3.317(a)(1)(i).

As an initial matter, the Veteran's military personnel records reflect that from October 5, 2006, through October 6, 2006, he served in Iraq, and from May 20, 2007, through June 6, 2007, he served in Kuwait. Accordingly, the Board finds that the Veteran has a qualifying period of service and therefore qualifies as a Persian Gulf veteran. See 38 C.F.R. § 3.317(e).

Regarding the issue of a qualifying chronic disability, the Board concludes that it is bound by the favorable finding in the September 2019 Rating Decision that the Veteran suffers from chronic diarrhea. See 38 C.F.R. § 3.104(c).

In addition, Dr. L.'s February 2021 Report states that the Veteran suffers from IBS, which is a functional gastrointestinal disorder. See 38 C.F.R. § 3.317(a) (2)(i)(B)(3). Accordingly, the Board finds that the element of a qualifying chronic disability has also been established. See id.

Finally, regarding the issue of onset of the qualifying chronic disability, the Veteran submitted a February 2024 written statement (the "February 2024 Statement") which states that he "first started experiencing issues with recurrent diarrhea and constipation" during his service in Southwest Asia," and that his gastrointestinal symptoms have "persisted ever since." In addition, Dr. L.'s February 2021 Report supports the Veteran's claims by stating as follows: (1) for "several years," the Veteran has dealt with bouts of diarrhea and overall bowel distress that he self-treated with medication; and (2) due to "embarrassment and fears about painful treatment options," the Veteran "chose not to complain about his symptoms during active service."

The Board finds that the Veteran is competent to describe the circumstances surrounding the onset of the symptoms of his gastrointestinal symptoms, including his recurrent diarrhea and constipation during service, see Layno, 6 Vet. App. at 469, as well as the observable and continued symptoms of his gastrointestinal symptoms. See Jandreau, 492 F.3d at 1376-77. In addition, the Board finds the lay evidence submitted by the Veteran to be credible, as the statements are consistent with the facts and circumstances of his service as well as with the other evidence of record. See Caluza, 7 Vet. App. at 511; see also 38 U.S.C. § 1154(a). Therefore, the Board finds the evidence of record to at least be in relative equipoise on this issue, and therefore, affording the Veteran the benefit of the doubt, the Board finds that the Veteran's gastrointestinal symptoms began during his active military service in Southwest Asia. See 38 C.F.R. § 3.317(a)(1)(i).

Accordingly, in light of the foregoing, and despite the existence of a negative opinion of record, the Board finds the evidence of record is at least in relative equipoise regarding all three elements of the Veteran's service connection claim.
See Caluza, 7 Vet. App. at 511; see also 38 U.S.C. § 1154(a). Therefore, the Board finds the evidence of record to at least be in relative equipoise on this issue, and therefore, affording the Veteran the benefit of the doubt, the Board finds that the Veteran's gastrointestinal symptoms began during his active military service in Southwest Asia. See 38 C.F.R. § 3.317(a)(1)(i).

Accordingly, in light of the foregoing, and despite the existence of a negative opinion of record, the Board finds the evidence of record is at least in relative equipoise regarding all three elements of the Veteran's service connection claim. Therefore, the application of the benefit of the doubt doctrine is warranted in this case, and the claim is granted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

REASONS FOR REMAND

1. Entitlement to a rating in excess of 20 percent for the service-connected lumbar spine disability is remanded.

2. Entitlement to an initial rating in excess of 10 percent for the service-connected right lower extremity radiculopathy is remanded.

3. Entitlement to an initial rating in excess of 10 percent for the service-connected left lower extremity radiculopathy is remanded.

The Board must remand an appeal to the AOJ for correction of an error on the part of the AOJ to satisfy its duties under 38 U.S.C. § 5103A if the error occurred prior to the date of the AOJ decision on appeal. See 38 C.F.R. § 20.802. Although the Board sincerely regrets the delay, the remaining claims must be remanded for correction of such an error.

The Veteran's service-connected lumbar spine disability has been awarded a 20 percent rating, effective January 6, 2012, and his service-connected bilateral lower extremity radiculopathy has been awarded separate 10 percents rating, effective February 7, 2019. However, the Veteran asserts that his lumbar spine disability and his bilateral lower extremity radiculopathy warrant ratings in excess of those currently awarded.

In August 2018, the Veteran was afforded a VA lumbar spine examination which culminated in a report (the "August 2018 VA Spine Report") diagnosing the Veteran with lumbar spine degenerative arthritis; intervertebral disc syndrome (IVDS); lumbar spine osteoarthritis; lumbar spine degenerative disc disease (DDD); and radiculopathy of the bilateral lower extremities. The August 2018 VA Spine Report further indicates as follows: (1) the Veteran reported intense pain in his lower, middle, and upper back over the years; (2) the Veteran reported that he suffers from a constant dull low back pain; and (3) the Veteran was prescribed Meloxicam and Flexeril as needed.

When VA undertakes to provide a VA medical opinion, it must ensure that the opinion is adequate, see Barr v. Nicholson, 21 Vet. App. 303, 310-11 (2007), which in this context requires that an examination report sufficiently inform the Board of a medical expert's judgment on a medical question, address all relevant theories of entitlement, rely upon accurate factual premises, including the Veteran's lay statements regarding symptomatology, and present a fully articulated, sound rationale. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008).

Moreover, where VA diagnostic codes do not reference medication, the Board must discount any beneficial effects of medication taken by the Veteran to treat a disability and evaluate the baseline severity of the disability when assigning an evaluation. See Ingram v. Collins, 38 Vet. App. 130, 132 (2025) (citing Jones v. Shinseki, 26 Vet. App. 56 (2012)).

However, in this case, the August 2018 VA Spine Report failed to provide the following information necessary to adjudicate the Veteran's claims: (1) consideration of any ameliorating effects of the medication reported by the Veteran to treat his lumbar spine and radiculopathy pain and symptoms; (2) an indication that the effects of such medication were not considered and were, in fact, discounted in formulating opinions pertaining to the functional impairment caused by the Veteran's service-connected lumbar spine and radiculopathy; (3) the extent to which, if any, the Veteran's use of medication alleviates the symptoms of the service-connected lumbar spine and radiculopathy; and (4) the estimated functional impairment of the service-connected
, the August 2018 VA Spine Report failed to provide the following information necessary to adjudicate the Veteran's claims: (1) consideration of any ameliorating effects of the medication reported by the Veteran to treat his lumbar spine and radiculopathy pain and symptoms; (2) an indication that the effects of such medication were not considered and were, in fact, discounted in formulating opinions pertaining to the functional impairment caused by the Veteran's service-connected lumbar spine and radiculopathy; (3) the extent to which, if any, the Veteran's use of medication alleviates the symptoms of the service-connected lumbar spine and radiculopathy; and (4) the estimated functional impairment of the service-connected lumbar spine and radiculopathy absent any beneficial effects of the medication used by the Veteran during the period on appeal. See id.; Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007).

Accordingly, the failure to obtain an adequate medical examination in connection with the Veteran's claims prior to the September 2019 Rating Decision and the October 2019 Rating Decision constituted a pre-decisional duty to assist error, and remand is required in order to obtain a VA examination that further assesses the Veteran's lumbar spine and bilateral lower extremity radiculopathy. See 38 C.F.R. § 20.802(a).

Accordingly, these matters are REMANDED for the following action:

Schedule the Veteran for a VA examination to determine the severity and manifestations of the service-connected lumbar spine disability and bilateral lower extremity radiculopathy. The entire claims folder should be made available to and be reviewed by the clinician. The clinician must consider all of the Veteran's statements of record, as well as any other lay statements, regarding symptomatology.

(a.) The clinician must discuss all evidence of record regarding the severity, frequency, and duration of any lumbar spine flare-ups, as well as precipitating and alleviating factors, and the functional effects of repeated use over time.

(b.) The clinician should provide an estimate, if at all possible, of additional impairment due to any lumbar spine flare-ups and repeated use over time based on the evidence of record and the totality of the Veteran's statements.

Please note that the Board cannot accept a rationale that the Veteran was not observed during a flare-up or after repeated use over time to explain why the range of motion values cannot be provided. If the clinician is unable to provide such an opinion without resorting to speculation, the clinician should provide a rationale for this conclusion, considering the Veteran's statements in the record regarding the extent to which the flare-ups affect functional impairment.

(c.) The clinician is asked to address whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that during flare-ups or with repeated use over time, forward flexion of the lumbar spine would be limited to 30 degrees or less or function of the lumbar spine would be equivalent to ankylosis. Please provide this response using information procured from relevant sources of record in addition to examination reports, including lay statements and testimony from the Veteran.

If the clinician determines there is no additional range of motion loss during flare-ups when compared with initial range of motion and/or repetitive use testing, the clinician must attempt to reconcile this finding with the Veteran's lay statements regarding flare-ups.

(d.) The clinician is also asked to specifically discuss the following:

i. Please identify all medications prescribed to the Veteran for treatment of the Veteran's service-connected lumbar spine and bilateral lower extremity radiculopathy disabilities, including but not limited to Meloxicam and Flexeril.

ii. Please identify any ameliorating effects of the medication prescribed to the Veteran for treatment of the Veteran's service-connected lumbar spine and bilateral lower extremity radiculopathy disabilities.

iii. Please clarify whether the effects of such medication were considered or not, and whether such effects were discounted in formulating opinions pertaining to functional impairment caused by the service-connected lumbar spine and bilateral lower extremity radiculopathy disabilities.

iv. Please identify the extent to which, if any, the Veteran's use of medication alleviated the symptoms of the service-connected lumbar spine and bilateral lower extremity radiculopathy disabilities, including (A) whether the Veteran's use of medication alleviated the relevant lumbar spine and bilateral lower extremity radiculopathy symptoms; and (B) whether the Veteran's use of medication impacted the lumbar spine estimated range of motion.

In formulating the requested opinions, the clinician should consider and discuss the competent medical and lay evidence of record, including but not limited to the Veteran's medical records and the Veteran's competent
functional impairment caused by the service-connected lumbar spine and bilateral lower extremity radiculopathy disabilities.

A complete rationale should be provided for the requested opinions. If it is not possible to provide a requested opinion without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts); a deficiency in the record (additional facts are required); or is because the examiner does not have the requisite knowledge or training.

L. STEPANICK

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board H. Marsdale, Counsel

The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.

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