Citation Nr: 1318624 Decision Date: 06/07/13 Archive Date: 06/11/13 DOCKET NO. 12-18 039 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in North Little Rock, Arkansas THE ISSUE Entitlement to service connection for L4-L5 disc degeneration and posterior disc contusions (claimed as a low back disability). (Additional claims of service connection for chronic fatigue syndrome, migraine headaches, hiatal hernia, gastroesophageal reflux disease (GERD), left lower extremity numbness, right lower extremity numbness, left shoulder bursitis/subluxation (claimed as left shoulder pain), right shoulder bursitis/subluxation (claimed as right shoulder pain), left elbow bursitis (claimed as left elbow pain), right elbow bursitis (claimed as right elbow pain), left hip bursitis (claimed as left hip pain), right hip bursitis (claimed as right hip pain), left ankle bursitis (claimed as left ankle pain), right ankle bursitis (claimed as right ankle pain), left knee patellofemoral syndrome with ligamentous pain, and right knee patellofemoral syndrome with ligamentous pain, and a claim for compensable rating for C6 and C7 radiculopathy of the left arm with left carpal tunnel syndrome will be addressed in a separate decision.) REPRESENTATION Appellant represented by: The American Legion WITNESS AT HEARING ON APPEAL The Veteran ATTORNEY FOR THE BOARD Cheryl E. Handy, Associate Counsel INTRODUCTION The Veteran, who is the appellant, served on active duty from March 1986 to October 1986, from December 1990 to June 1991, and from October 2001 to May 2003, with additional service in the Army Reserves. This matter is before the Board of Veterans' Appeals (Board) on appeal of a rating decision in November 2007 of a Department of Veterans Affairs (VA) Regional Office (RO). Current jurisdiction over this claim rests with the Houston, Texas RO. In March 2010, the Veteran appeared at a Board hearing before the undersigned Veterans Law Judge. A transcript of that hearing is in the claims file. This case was previously before the Board in August 2010, when it was remanded for further development, to include obtaining a VA examination and opinion with respect to the issue of service connection for the claimed low back disability. As the opinion obtained did not fully address the issue on appeal, this matter must be remanded again to ensure compliance with the remand directive. Stegall v. West, 11 Vet. App. 268 (1998). The Veteran had a separate hearing at the RO in February 2013 before a different Veterans Law Judge regarding claims of service connection for chronic fatigue syndrome, migraine headaches, hiatal hernia, gastroesophageal reflux disease (GERD), left lower extremity numbness, right lower extremity numbness, left shoulder bursitis/subluxation (claimed as left shoulder pain), right shoulder bursitis/subluxation (claimed as right shoulder pain), left elbow bursitis (claimed as left elbow pain), right elbow bursitis (claimed as right elbow pain), left hip bursitis (claimed as left hip pain), right hip bursitis (claimed as right hip pain), left ankle bursitis (claimed as left ankle pain), right ankle bursitis (claimed as right ankle pain), left knee patellofemoral syndrome with ligamentous pain, and right knee patellofemoral syndrome with ligamentous pain, and a claim for compensable rating for C6 and C7 radiculopathy of the left arm with left carpal tunnel syndrome. This other claim will be addressed in a separate Board decision authored by the Veterans Law Judge who presided over that hearing. See 38 U.S.C.A. § 7107(c) (West 2002); 38 C.F.R. § 20.707 (2012) (the Veterans Law Judge who conducts a hearing on an issue on appeal must participate in the any decision rendered on that issue). The appeal of entitlement to service connection for L4-L5 disc degeneration and posterior disc contusion is REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. VA will notify the appellant if further action is required. REMAND In August 2010, the Board remanded this appeal and directed that the Veteran be afforded a VA examination and opinion which addressed her claim of service connection for low back disability. In rendering the opinion, the VA examiner was instructed to consider the in-service and post-service treatment record and the Veteran's own lay statements regarding the disability. In December 2011, the Veteran was afforded a VA examination which included evaluation of her low back disability claim. The opinion provided is confusing in nature, with many incomplete sentences and ideas, and does not address the central question of whether the Veteran's back pain in service was related to or the cause of her current low back disability. As such, the claim must be remanded again for clarification of the opinion or a new examination and opinion. Accordingly, the case is REMANDED for the following action: 1. Obtain a clarification of the December 2011 VA examiner's opinion with respect to the low back disability claim. If the provider who examined the Veteran in December 2011 is not available, then a new evaluation and opinion should be obtained. Any physical examination of the Veteran should be scheduled at a location convenient to the Veteran's residence in Texarkana, Texas. The examiner should specifically review the records from chiropractic treatment in 2002 and 2003 which show adjustment of L4 and the right and left sciatic joint and subluxations in the lumbar spine. The examiner is asked to address whether the Veteran's current low back disability, i.e., L4-L5 disc degeneration and posterior disc contusions, was at least as likely as not (probability greater than 50 percent) incurred in or aggravated by her military service, to include whether the back pain and subluxations noted by the chiropractor during her active duty service is related to her current disability. The examiner should provide the rationale for any opinion(s) rendered. A copy of the claims file should be provided to the examiner for review. 2. The RO should also undertake any other indicated development suggested by the development ordered above. The RO should review the opinion provided to ensure that it contains a complete rationale and a clear opinion in its printed form. 3. On completion of the foregoing, the claim should be adjudicated. If the decision remains adverse to the Veteran, then provide her and her representative a supplemental statement of the case and return the case to the Board. The Veteran has the right to submit additional evidence and argument on the matter the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2012). _________________________________________________ Eric S. Leboff Veterans Law Judge, Board of Veterans' Appeals Under 38 U.S.C.A. § 7252 (West 2002), only a decision of the Board of Veterans' Appeals is appealable to the United States Court of Appeals for Veterans Claims. This remand is in the nature of a preliminary order and does not constitute a decision of the Board on the merits of your appeal. 38 C.F.R. § 20.1100(b) (2012).