5243 Intervertebral Disc Syndrome.  However, there is no evidence of incapacitating episodes as contemplated by the regulation, and neither the lay or medical evidence suggests that there has been physician prescribed bed rest.  In light of the lack of evidence demonstrating any episodes requiring bed rest prescribed by a physician and treatment by a physician for Intervertebral Disc Syndrome, and indeed, in light of the lack any assertion on the part of the Veteran that the criteria for incapacitating episodes have been met, the Board finds that a higher rating under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes is not warranted.

Again, as the Veteran failed to report for the examination scheduled in 2013, no further determination can be made on the manifestationsof motion.  

Also in January 2008, the Veteran reported increased right shoulder pain and noted that it occasionally woke her up at night.  She rated her pain a level of 7 out of 10 at worse.

Objectively, there was no swelling or effusion.  A sulcus test was positive, while load and shift tests were negative.  Scapulohumeral rhythm was fair.  She had increased difficulty lowering her right upper extremity after elevating it above shoulder level and had to shift the position of the humerus in relation to the glenoid in order to lower it back to neutral.  Range of motion was within normal limits.  An assessment of right upper extremity degenerative joint disease and instability with labral tear was noted.

The May 2008 Physical