ERECTILE DYSFUNCTION

J. T. HUTCHESON · 2026 · Case ID: A26039875

MIXED

Summary

The veteran served from February 1971 to November 1973. The veteran appeals the denial of service connection for erectile dysfunction, an earlier effective date for adjustment disorder with depressed mood, and the dismissal of the appeal for GERD. The Board granted service connection for erectile dysfunction, finding it related to the service-connected adjustment disorder with depressed mood, as determined by the Agency of Original Jurisdiction. The Board denied an earlier effective date for adjustment disorder with depressed mood, noting that the veteran's claim for psychiatric disability was initially denied in 1974 and no intervening claim or intent to file was received until November 2020, making November 6, 2020, the correct effective date. The Board dismissed the appeal for GERD as duplicative and improperly docketed. The case was remanded for further development on several issues: entitlement to a rating in excess of 20 percent for lumbosacral strain residuals and spondylosis, service connection for right lower extremity radiculopathy, an initial rating in excess of 30 percent for adjustment disorder with depressed mood, and entitlement to TDIU. The remands were based on inadequate VA examinations, specifically noting the failure to address medication effects, the degree of pain onset, or the impulse control disorder diagnosis in relation to the adjustment disorder.

Rationale

Service connection may be granted for recurrent disability arising from disease or injury incurred in or aggravated by active service.; The Agency of Original Jurisdiction determined erectile dysfunction was related to the service-connected adjustment disorder with depressed mood.; In the absence of clear and unmistakable error, service connection is granted.

Special Benefit

TDIU; EARLIER EFFECTIVE DATE

Docket No.

211027-193778

Full Decision Text

Citation Nr: A26039875
Decision Date: 04/29/26 Archive Date: 04/29/26

DOCKET NO. 211027-193778
DATE: April 29, 2026

ORDER

Entitlement to service connection for erectile dysfunction is granted.

An effective date prior to November 6, 2020, for the award of service connection for adjustment disorder with depressed mood is denied.

The appeal for service connection for a recurrent esophageal disability to include gastroesophageal reflux disease (GERD) is dismissed.

REMANDED

Entitlement to a rating in excess of 20 percent for lumbosacral strain residuals and spondylosis is remanded.

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

Entitlement to a rating in excess of 30 percent for adjustment disorder with depressed mood is remanded.

Entitlement to a total rating for compensation purposes based on individual unemployability due to service-connected disabilities (TDIU) is remanded.

FINDINGS OF FACT

1. The Agency of Original Jurisdiction determined that erectile dysfunction is related to the service-connected adjustment disorder with depressed mood.

2. Adjustment disorder with depressed mood has been shown to have originated during active service.

3. The Veteran's November 2020 Application for Disability Compensation and Related Compensation Benefits, VA Form 21-526EZ, seeking service connection for a psychiatric disability was received by the Department of Veterans Affairs (VA) on November 6, 2020.

4. The issue of entitlement to service connection for a recurrent esophageal disability to include GERD was improperly docketed before the Board of Veterans' Appeals (Board) under the Appeals Modernization Act due to a procedural defect.

CONCLUSIONS OF LAW

1. The criteria for service connection for erectile dysfunction have been met. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.104(c), 3.303.

2. The criteria for an effective date prior to November 6, 2020, for the award of service connection for adjustment disorder with depressed mood have not been met. 38 U.S.C. § 5110; 38 C.F.R. §§ 3.155, 3.158, 3.400, 3.2500.

3. The criteria for dismissal of the appeal for service connection for a recurrent esophageal disability to include GERD have been met. 38 U.S.C. § 7105.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran had active service from February 1971 to November 1973.

The Veteran appeared at a November 2024 virtual hearing before the undersigned Veterans Law Judge. The hearing transcript is of record.

In January 2021, the Agency of Original Jurisdiction granted service connection for adjustment disorder with depressed mood; assigned a 30 percent rating for that disability, effective November 6, 2020; denied a rating in excess of 20 percent for lumbosacral strain residuals and spondylosis; and denied service connection for right lower extremity radiculopathy. In January 2021, the Agency of Original Jurisdiction denied service connection for erectile dysfunction. In October 2021, the Veteran submitted a Decision Review Request: Board Appeal (Notice of Disagreement), VA Form 10182, and elected the Hearing docket. Therefore, the Board may only consider the evidence of record at the time of the Agency of Original Jurisdiction decisions on appeal, as well as any evidence submitted by the Veteran at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). If evidence was submitted either (1) during the periods after the Agency of Original Jurisdiction issued the Agency of Original Jurisdiction decisions on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801. If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim, VA Form 20-0995, and submit or identify this evidence. If the evidence is new and relevant, VA will issue another decision on the claims, considering the new evidence in addition to the evidence previously considered. 38 C.F.R. § 3.2501. Specific instructions for filing a Supplemental Claim are included with this decision. However, as the Board is remanding the issues of service connection for right lower extrem
in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801. If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim, VA Form 20-0995, and submit or identify this evidence. If the evidence is new and relevant, VA will issue another decision on the claims, considering the new evidence in addition to the evidence previously considered. 38 C.F.R. § 3.2501. Specific instructions for filing a Supplemental Claim are included with this decision. However, as the Board is remanding the issues of service connection for right lower extremity radiculopathy; a rating in excess of 20 percent for lumbosacral strain residuals and spondylosis; a rating in excess of 30 percent for adjustment disorder with depressed mood; and a TDIU, any evidence the Board could not consider will be considered by the Agency of Original Jurisdiction in the adjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii).

At the November 2024 Board hearing, the Veteran testified that the service connected disabilities rendered him unable to secure or follow any full time employment. When entitlement to a TDIU is reasonably raised during the adjudicatory process of evaluating the underlying disability or disabilities, it is part of the claim for benefits for the underlying disability or disabilities. Rice v. Shinseki, 22 Vet. App. 447, 454 (2009). Therefore, the issue of entitlement to a TDIU is on appeal and will be addressed below.

In May 2021, the Agency of Original Jurisdiction granted service connection for erectile dysfunction; assigned a noncompensable rating for that disability; and effectuated the award as of October 20, 2020. The Board notes that a subsequent Agency of Original Jurisdiction decision cannot divest the Board of jurisdiction over a prior appeal and the Agency of Original Jurisdiction's grant of service connection for erectile dysfunction cannot finally decide the claim of service connection already on appeal before the Board. See Green v. McDonough, 37 Vet. App. 127, 136-48 (2024); Bailey v. Wilkie, 33 Vet. App. 188, 204 (2021); see also Warren v. McDonald, 28 Vet. App. 214, 221 (2016).

Service Connection for Erectile Dysfunction

Service connection may be granted for recurrent disability arising from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d).

The Board is bound by favorable findings by the Agency of Original Jurisdiction in the absence of evidence of clear and unmistakable error. 38 C.F.R. § 3.104(c).

In his October 2020 Application for Disability Compensation and Related Compensation Benefits, VA Form 21-526EZ, the Veteran reported that he "started having difficulty maintaining [an] erection due to [his] chronic back pain."

In an October 2020 Statement in Support of Claim, VA Form 21-4138, the Veteran stated that his service-connected disabilities have caused him "to find it difficult to be intimate with [his] partner and perform sexually."

In May 2021, the Agency of Original Jurisdiction determined that erectile dysfunction was related to the service-connected adjustment disorder with depressed mood. Considering such a finding, and in the absence of evidence of clear and unmistakable error to the contrary, service connection for erectile dysfunction is granted. 38 C.F.R. §§ 3.104(c), 3.303.

Earlier Effective Date

The Veteran asserts that an effective date prior to November 6, 2020, is warranted for the award of service connection for adjustment disorder with depressed mood.

For claims under the Legacy appeals system, a veteran must file a Notice of Disagreement, VA Form 21-0958, with a determination by the Agency of Original Jurisdiction within one year from the date that the Agency of Original Jurisdiction mails the notice of the determination. After the veteran has initiated an appeal with a notice of disagreement, a substantive appeal must be filed within 60 days from the date the Agency of Original Jurisdiction mailed the statement of the case or within the remainder of the one-year period from the date of mailing of the rating decision being appealed, whichever is later. 38 C.F.R. §§
, 2020, is warranted for the award of service connection for adjustment disorder with depressed mood.

New evidence means existing evidence not previously submitted to agency decision makers. Material evidence means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. There is a low threshold to raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a); Shade v. Shinseki, 24 Vet. App. 110 (2010); Evans v. Brown, 9 Vet. App. 273 (1996); Hodge v. West, 155 F.3d 1356 (Fed. Cir. 1998).

In regard to pending Legacy claims not under the Appeals Modernization Act (AMA) appeals system, new and material evidence received prior to the expiration of the appeal period, or prior to the appellate decision if a timely appeal has been filed (including evidence received prior to an appellate decision and referred to the Agency of Original Jurisdiction by the Board without consideration in that decision in accordance with the provisions of 38 C.F.R. § 20.1304(b)(1)), will be considered as having been filed in connection with the claim which was pending at the beginning of the appeal period. 38 C.F.R. § 3.156(b). Prior to February 19, 2019, all claims were subject to the provisions of 38 C.F.R. § 3.156(b).

The term "date entitlement arose" is not defined in the current statute or regulation. However, the Court has interpreted it as the date when the claimant met the requirements for the benefits sought. This is determined on a "facts found" basis. See 38 U.S.C. § 5110(a); McGrath v. Gober, 14 Vet. App. 28, 35 (2000). An effective date generally can be no earlier than the "facts found." DeLisio v. Shinseki, 25 Vet. App. 45 (2011). These "facts found" include the date the disability first manifested and the date entitlement to benefits was authorized by law and regulation. See 38 C.F.R. § 3.400. For instance, if a claimant filed a claim for benefits for a disability before he actually had the disability, the effective date for benefits can be no earlier than the date the disability first manifested. Ellington v. Peake, 541 F.3d 1364, 1369-70 (Fed. Cir. 2008). However, the date entitlement arose is not the date that the Agency of Original Jurisdiction receives the evidence, but the date to which that evidence refers. McGrath, 14 Vet. App. at 35. It is possible that a particular piece of evidence demonstrates that the Veteran suffered from the symptoms of a disability or rating level earlier than the date of the examination, opinion, or diagnosis. DeLisio, 25 Vet. App. at 56.

Generally, the effective date for an award of service connection is the day after service separation or the date entitlement arose, whichever is later, if the claim is received within one year of the date of separation from service. Otherwise, the effective date will be the date of receipt of the claim, or the date entitlement arose, whichever is later. Where a claim for service connection is reopened and granted based upon new and relevant evidence, other than service records, received after the prior rating decision has become final, the effective date will be the date of receipt of claim to reopen or date entitlement arose, whichever is later. 38 U.S.C. § 5110; 38 C.F.R. §§ 3.160(d), 3.400, 3.2500.

For supplemental claims received more than one year after the date on which the Agency of Original Jurisdiction issued a decision, the effective date shall be fixed in accordance with the facts found but shall not be
will be the date of receipt of the claim, or the date entitlement arose, whichever is later. Where a claim for service connection is reopened and granted based upon new and relevant evidence, other than service records, received after the prior rating decision has become final, the effective date will be the date of receipt of claim to reopen or date entitlement arose, whichever is later. 38 U.S.C. § 5110; 38 C.F.R. §§ 3.160(d), 3.400, 3.2500.

On and after March 24, 2015, claims for VA benefits are to be submitted on the appropriate claims form. 38 C.F.R. §§ 3.151, 3.155. A claimant may indicate a desire to file a claim for benefits by submitting an intent to file a claim to VA. If VA receives a complete application form prescribed by the Secretary within one year of receipt of the intent to file a claim, VA will consider the complete claim filed as of the date the intent to file a claim was received. The submission to an Agency of Original Jurisdiction of a signed and dated intent to file a claim, on the form prescribed by the Secretary for that purpose, will be accepted as an intent to file a claim. 38 C.F.R. § 3.155(b).

The Veteran's December 1973, Veteran's Application for Compensation or Pension, VA Form 21-526, seeking service connection for psychiatric disability was received by VA on December 5, 1973.

In December 1974, the Agency of Original Jurisdiction denied service connection for psychiatric disability as the disability was "not shown by the evidence of record." In December 1974, the Veteran was informed in writing of the decision and his appellate rights. The Veteran did not submit a notice of disagreement with the adverse decision.

The Veteran's November 2020 Application for Disability Compensation and Related Compensation Benefits, VA Form 21-526EZ, seeking service connection for a psychiatric disability was received by VA on November 6, 2020.

In January 2021, the Agency of Original Jurisdiction granted service connection for adjustment disorder with depressed mood and assigned a 30 percent rating, effective November 6, 2020.

Adjustment disorder with depressed mood has been shown to have originated during active service. The Veteran's December 1973, Veteran's Application for Compensation or Pension, VA Form 21-526, seeking service connection for psychiatric disability was received by VA on December 5, 1973. In December 1974, the Agency of Original Jurisdiction denied service connection for a psychiatric disability. In December 1974, the Veteran was informed in writing of the decision and his appellate rights. The Veteran did not submit a notice of disagreement with the adverse decision. The Veteran's November 2020 Application for Disability Compensation and Related Compensation Benefits, VA Form 21-526EZ, seeking service connection for a psychiatric disability was received by VA on November 6, 2020. A review of the record does not reveal either a claim for service connection for a psychiatric disability or an Intent to File such a claim which was received by VA between the December 1974 Agency of Original Jurisdiction decision which denied service connection for nervous condition and November 6, 2020. Therefore, the appropriate effective date for the award of service connection for adjustment disorder with depressed mood is November 6, 2020, the date of VA's receipt of the VA Form 21-526EZ. 38 U.S.C. § 5110(b)(1); 38 C.F.R. §§ 3.155(b), 3.158, 3.400(b)(2)(i). Accordingly, an effective date prior to November 6, 2020, for the award of service connection for adjustment disorder with depressed mood is denied.

Dismissal

An appeal of a decision by the Agency of Original Jurisdiction consists of a notice of disagreement submitted to the Board in accordance with the provisions of §§ 20.202-20.204, 38 C.F.R. § 20.201. A notice of disagreement must be properly completed on a form prescribed by the Secretary of VA. If the Agency of Original Jurisdiction decision addressed several issues, the notice of disagreement must identify the specific decision and issue or issues therein with which the claimant disagrees. The term "issue" means an adjudication of a
Accordingly, an effective date prior to November 6, 2020, for the award of service connection for adjustment disorder with depressed mood is denied.

Dismissal

An appeal of a decision by the Agency of Original Jurisdiction consists of a notice of disagreement submitted to the Board in accordance with the provisions of §§ 20.202-20.204, 38 C.F.R. § 20.201. A notice of disagreement must be properly completed on a form prescribed by the Secretary of VA. If the Agency of Original Jurisdiction decision addressed several issues, the notice of disagreement must identify the specific decision and issue or issues therein with which the claimant disagrees. The term "issue" means an adjudication of a specific entitlement as described in 38 C.F.R. § 3.151(c). The Board will construe such arguments in a liberal manner for purposes of determining whether they raise issues on appeal, but the Board may dismiss any appeal which fails to identify the specific decision and issue or issues therein with which the claimant disagrees. 38 C.F.R. § 20.201.

Claimants may elect to review a decision by the Agency of Original Jurisdiction by filing a Decision Review Request: Supplemental Claim Supplemental Claim Application, VA Form 20-0995; a Decision Review Request: Higher-Level Review, VA Form 20-0996, or a Decision Review Request: Board Appeal (Notice of Disagreement), VA Form 10182. Concurrent election of review of a VA decision under different appeal lanes is not permitted. 38 C.F.R. § 3.2500. The United States Court of Appeals for Veterans Claims (Court) clarified that a claimant is able to select a second administrative review option with respect to a decision on the claim, so long as the one-year period from that decision has not run and the second administrative review option does not run concurrently with the first administrative review option. Terry v. McDonough, 37 Vet. App. 1 (2023).

In January 2021, the Agency of Original Jurisdiction denied service connection for GERD. On January 28, 2021, the Agency of Original Jurisdiction provided the Veteran with written notice of the adverse decision and his appellate rights.

In May 2021, the Agency of Original Jurisdiction denied service connection for GERD. On May 20, 2021, the Agency of Original Jurisdiction provided the Veteran with written notice of the adverse decision and his appellate rights.

In July 2021, the Veteran submitted a Decision Review Request: Board Appeal (Notice of Disagreement), VA Form 10182, appealing the issue of service connection for GERD from the May 2021 Agency of Original Jurisdiction decision. On July 21, 2021, the Board docketed the July 2021 VA Form 10182 and informed the Veteran of its action.

In October 2021, the Veteran submitted a Decision Review Request: Board Appeal (Notice of Disagreement), VA Form 10182, appealing the issue of service connection for GERD from the January 2021 Agency of Original Jurisdiction decision. On October 28, 2021, the Board docketed the October 2021 VA Form 10182 and informed the Veteran of its action.

The October 2021 Decision Review Request: Board Appeal (Notice of Disagreement), VA Form 10182, as to the issue of service connection for GERD, was submitted while the July 2021 Decision Review Request: Board Appeal (Notice of Disagreement), VA Form 10182, remained pending. Therefore, the Board finds that the issue of service connection for GERD from the October 2021 VA Form 10182 is duplicative of the issue of service connection for GERD from the July 2021 VA Form 10182, thus the October 2021 VA Form 10182 was improperly docketed as to the issue of service connection for GERD due to a procedural defect and the noted appeal must be dismissed. 38 U.S.C. § 7105(d).

The Board notes that the appeal seeking service connection for GERD arising from the July 2021 VA Form 10182 is the subject of a separate Board decision.

REASONS FOR REMAND

1. Entitlement to a rating in excess of 20 percent for lumbosacral strain residuals and spondylosis is remanded.

The Veteran asserts that a rating in excess of 20 percent is warranted for the service-connected lumbosacral spine disability.

Unfortunately, a remand is required in this case. Although the Board sincerely regrets the additional delay, it is necessary to ensure that there is a complete record upon which to decide the claims.

VA's duty to
.C. § 7105(d).

The Board notes that the appeal seeking service connection for GERD arising from the July 2021 VA Form 10182 is the subject of a separate Board decision.

REASONS FOR REMAND

1. Entitlement to a rating in excess of 20 percent for lumbosacral strain residuals and spondylosis is remanded.

The Veteran asserts that a rating in excess of 20 percent is warranted for the service-connected lumbosacral spine disability.

Unfortunately, a remand is required in this case. Although the Board sincerely regrets the additional delay, it is necessary to ensure that there is a complete record upon which to decide the claims.

VA's duty to assist includes, in appropriate cases, the duty to conduct a thorough and contemporaneous medical examination which is accurate and fully descriptive. McLendon v. Nicholson, 20 Vet. App. 79 (2006); Green v. Derwinski, 1 Vet. App. 121, 124 (1991). When VA undertakes to obtain an evaluation, it must ensure that the evaluation is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The Board is required "to discount beneficial medication effects when relevant rating criteria do not specifically contemplate medication use." Ingram v. Collins, 38 Vet. App.?130 (2025); see also Jones v. Shinseki, 26 Vet. App. 56 (2012).

Generally, lumbar spine disabilities are to be rated under the General Rating Formula for Diseases and Injuries of the Spine or the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, whichever method results in the higher evaluation when all disabilities are combined under 38 C.F.R. § 4.25. 38 C.F.R. § 4.71a, Diagnostic Codes 5237, 5242.

The General Rating Formula for Diseases and Injuries of the Spine directs that a 20 percent rating is warranted where there is either forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; the combined range of motion of the thoracolumbar spine not greater than 120 degrees; the combined range of motion of the cervical spine not greater than 170 degrees; or muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 40 percent rating will be assigned for forward flexion of the thoracolumbar spine 30 degrees or less or favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent rating is to be assigned for unfavorable ankylosis of the entire spine. Associated objective neurologic abnormalities are to be separately rated under an appropriated diagnostic code.

The use of medications is not contemplated in either the General Rating Formula for Diseases and Injuries of the Spine.

VA clinical documentation dated in July 2019 states that the Veteran was prescribed lidocaine patches and gabapentin for treatment of back pain. A January 2020 VA treatment report states that the Veteran was prescribed lidocaine patches and duloxetine for treatment of back pain.

The report of a December 2020 lumbar spine examination conducted for VA states that the Veteran reported having "moderate to severe back pain" with stiffness in the legs which caused "difficulty with lifting and bending." On examination of the lumbar spine, the Veteran exhibited active range of motion of forward flexion to 60 degrees, extension to 5 degrees, right and left lateral flexion to 30 degrees, right and left lateral rotation to 30 degrees; pain with extension and weight bearing; and functional loss due to pain. While noting that the pain caused functional loss, the examiner did not note the degree at which the low back pain began. Also, the examiner did not discuss any ameliorative effects of the Veteran's medications. Considering such deficiencies, the Board finds that the functional loss associated with the service-connected lumbosacral spine disability is unclear and the examination report is of limited probative value. Further VA lumbosacral spine evaluation is needed. That is a pre-decisional error.

2. Entitlement to service connection for right lower extremity radiculopathy is remanded.

The issue of service connection for right lower extremity radiculopathy is inextricably intertwined with the issue of an increased rating for lumbosacral strain residuals and spondylosis being remanded and must also be remanded.

3.
did not discuss any ameliorative effects of the Veteran's medications. Considering such deficiencies, the Board finds that the functional loss associated with the service-connected lumbosacral spine disability is unclear and the examination report is of limited probative value. Further VA lumbosacral spine evaluation is needed. That is a pre-decisional error.

2. Entitlement to service connection for right lower extremity radiculopathy is remanded.

3. Entitlement to an initial rating in excess of 30 percent for adjustment disorder with depressed mood is remanded.

The Veteran asserts that an initial rating in excess of 30 percent is warranted for the service-connected psychiatric disability.

A March 2015 VA mental health treatment record states that the Veteran "presents with a recent history suggestive of impulse control disorder." A January 2021 VA treatment report dated in states that the Veteran was diagnosed with impulse control disorder.

The report of a December 2020 psychiatric examination conducted for VA states that the Veteran was diagnosed with adjustment disorder with depressed mood. The examiner commented that the Veteran had symptoms of depressed mood and chronic sleep impairment. The examiner concluded that the service-connected psychiatric disability was productive of "[o]ccupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation." The examiner did not address or otherwise discuss the diagnosed impulse-control disorder noted in his VA treatment records. Considering such deficiency, the Board finds that the examination report is of limited probative value. Further VA psychiatric evaluation is needed. That is a pre-decisional error.

4. Entitlement to a TDIU is remanded.

The issue of entitlement to a TDIU is inextricably intertwined with the issues being remanded and must also be remanded.

The matters are REMANDED for the following action:

1. Schedule the Veteran for a VA lumbosacral spine examination conducted by a medical doctor to assist in determining the nature and severity of the service connected lumbosacral strain residuals and spondylosis. The examiner must review the record and should note that review in the report. A rationale for all opinions should be provided. The examiner should provide the following opinions:

(a) Provide ranges of motion for passive and active motion of the lumbosacral spine. The examiner should indicate the degree of spine motion at which any observed pain begins. The examiner should state whether there is any additional loss of lumbosacral spine function due to painful motion, weakened motion, excess motion, fatigability, or incoordination. The examiner should specifically discount any ameliorative effects of the Veteran's medications.

(b) Indicate whether, and to what extent, the Veteran experiences functional loss of the lumbosacral spine due to pain or any other symptoms during flare ups or with repeated use. The examiner should specifically discount any ameliorative effects of the Veteran's medications.

(c) State whether there is any actual or functional ankylosis of the lumbosacral spine or any other segment of the spine. The examiner should specifically discount any ameliorative effects of the Veteran's medications.

(d) Describe all identified lower extremity neurologic disabilities associated with the service-connected lumbosacral spine disability, the nerves affected, and the level of impairment. The examiner should specifically discount any ameliorative effects of the Veteran's medications.

2. Schedule the Veteran for a VA psychiatric examination to assist in determining the nature and severity of the service-connected psychiatric disability during the relevant period. A rationale for all opinions should be provided. The examiner should opine as to the levels of occupational and social impairment caused by the service-connected psychiatric disability and should describe the frequency and severity of symptoms resulting in those levels of impairment.

J. T. HUTCHESON

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Kuramoto, Justin U.

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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