Citation Nr: 1321905 Decision Date: 07/09/13 Archive Date: 07/18/13 DOCKET NO. 06-37 700 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Louis, Missouri THE ISSUE Entitlement to service connection for a tailbone disorder. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD D. Havelka, Counsel INTRODUCTION The Veteran served on active duty from September 1980 to August 1987 and from January 1988 to July 1990. This case comes to the Board of Veterans' Appeals (Board) on appeal from an August 2005 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Louis, Missouri, which in part, denied service connection for a tailbone condition. This appeal is remanded to the RO via the Appeals Management Center in Washington, DC. REMAND In a June 2011 remand, the Board directed the RO to afford the Veteran a VA examination pursuant to her claim of entitlement to service connection for a tailbone disorder. Therein, the examiner was asked to provide an opinion as to whether any current tailbone disorder was "partially or wholly" incurred in or due to the Veteran's active duty service. In so doing, the examiner was specifically requested to consider the Veteran's assertions that she experienced symptoms of a tailbone disorder since her active duty service. Additionally, the examiner was requested to provide an opinion as to whether any tailbone disorder was aggravated by a service-connected disability. In July 2011, the Veteran underwent a VA examination. During the examination, the Veteran claimed an onset of low back or tailbone pain in 1981. After reviewing the relevant evidence of record and administering a thorough clinical evaluation, the examiner rendered a diagnosis of "strain of the lumbo-sacral spine." The examiner's medical opinion did not appear to consider the Veteran's reports of the onset of low back or tailbone pain during service. Accordingly, the claim was remanded for an additional opinion. In March 2013, the examiner issued an addendum with another medical opinion. In the Veteran's initial claim in February 2005, she claimed a "tailbone condition." In a subsequent statement she more generally referred to neck and back conditions. Treatment records indicate reports of general back pain. The 2011VA examination focuses on the Veteran's cervical and thoracolumbar spine and does not give specific findings with respect to the tailbone (coccyx). However, in the March 2013 medical opinion addendum the examiner indicated that "L5-S1 can be considered the tailbone." Additional clarification by a physician is required along with additional adjudication. Additionally, service connection is in effect for post-operative hysterectomy with history of bilateral tubal ligation and atrophic ovaries; migraine headaches; major depression; trapezius strain of the left shoulder with chronic pain; trapezius strain of the right shoulder with chronic pain; patellofemoral pain syndrome, left knee; patellofemoral pain syndrome, right knee; degenerative disc disease of the cervical spine with chronic pain; and scar, laceration of left cheek. In both the June 2011 and October 2012 remands, the Board specifically requested that the examiner provide an opinion as to whether any of the Veteran's service-connected disabilities aggravated a current tailbone disorder. This medical opinion has not been provided. Remand is required. Stegall v. West, 11 Vet. App. 268, 271 (1998) (holding that a remand confers on the veteran, as a matter of law, the right to compliance with the remand orders). Accordingly, the case is remanded for the following action: 1. The examiner who conducted the July 2011 VA examination must provide an addendum to the opinion previously provided. If this examiner is unavailable, an opinion from a physician of the appropriate expertise must be obtained. The claims file and all records on Virtual VA must be made available to the examiner, and the examiner must specify in the examination report that the claims file and Virtual VA records have been reviewed. The examiner must specify the dates encompassed by the Virtual VA records that were reviewed. After review of the evidence of record, with consideration of the Veteran's reports of low back pain during service, the examiner must indicate: Does the evidence reveal any current disability of the coccyx? What is the exact diagnosis(es) of any thoracolumbar spine disorder found or previously diagnosed? Is any current low back disability, including of both the coccyx and the thoracolumbar spine, partially or wholly related to the Veteran's active duty service, to include any incident therein? Is any current disability of the coccyx and/or thoracolumbar spine disorder due to or aggravated by a service-connected disability? If the examiner determines that the requested opinions cannot be rendered without an examination, then the appropriate VA examination must be conducted. In rendering any etiological opinion, the examiner must address the Veteran's assertions that she experienced low back/tailbone pain during and since her active duty service. Further, the examiner must opine as to whether the Veteran's in-service symptoms and treatment are consistent with a current tailbone/low back disorder. A complete rationale for all opinions must be provided. If the examiner cannot provide the requested opinion without resorting to speculation, it must be so stated, and the examiner must provide the reasons why an opinion would require speculation. The examiner must indicate whether there was any further need for information or testing necessary to make a determination. Additionally, the examiner must indicate whether any opinion could not be rendered due to limitations of knowledge in the medical community at large and not those of the particular examiner. The report prepared must be typed. 2. If a new examination is required, the RO must notify the Veteran that it is her responsibility to report for the examination and to cooperate in the development of her claim. The consequences for failure to report for a VA examination without good cause may include denial of the claim. 38 C.F.R. §§ 3.158 , 3.655 (2012). In the event that the Veteran does not report for the examination, documentation must be obtained that shows that notice scheduling the examination was sent to the last known address. It must also be indicated whether any notice that was sent was returned as undeliverable. 3. After completing the above actions, and any other development as may be indicated by any response received as a consequence of the actions taken in the paragraphs above, the claims must be readjudicated. Specifically the issues of entitlement to service connection for a tailbone disorder and service connection for a disorder of the thoracolumbar spine must be adjudicated. If any benefit remains denied, a supplemental statement of the case must be provided to the Veteran and her representative. After the Veteran and her representative have had an adequate opportunity to respond, the appeal must be returned to the Board for appellate review. No action is required by the Veteran until she receives further notice; however, 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). _________________________________________________ JOY A. MCDONALD 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).