Citation Nr: 1322190 Decision Date: 07/11/13 Archive Date: 07/18/13 DOCKET NO. 13-07 635 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Louis, Missouri THE ISSUES 1. Entitlement to service connection for left leg numbness, paralysis, and radiculopathy, to include as secondary to residuals of service-connected inguinal hernia repair. 2. Entitlement to service connection for lumbar spine disability, to include as secondary to residuals of service-connected inguinal hernia repair. REPRESENTATION Veteran represented by: Missouri Veterans Commission ATTORNEY FOR THE BOARD Laura E. Collins, Associate Counsel INTRODUCTION The Veteran had unverified service in the Army from June 1949 to March 1951, and a period of verified service in the U.S. Marine Corps from March 1951 to September 1951. This matter comes before the Board of Veterans' Appeals (Board) on appeal of a September 2010 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Louis, Missouri. Please note this appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2012). 38 U.S.C.A. § 7107(a)(2) (West 2002). The appeal is REMANDED to the RO via the Appeals Management Center (AMC), in Washington, D.C. VA will notify the Veteran if further action is required. REMAND The Veteran's service treatment records, beyond those already associated with the claims file, have been determined to be unavailable. Those that are available show the Veteran expressing complaints of hypolgesia and analgesia in the lumbar area following hernia repair surgery in 1951, as well as complaints of numbness of the left foot. It appears that these complaints were considered to be the consequence of an inadequate personality. A post-service application for VA hospital treatment dated in March 1954 shows the Veteran presented with complaints of pain in the right buttock with radiation to the right foot for the past three weeks. It was also recorded that the Veteran had a myelogram in 1951 while in the Navy for low back pain. The 1954 diagnosis was chronic lumbosacral strain. The Veteran has identified relevant VA Medical Center (VAMC) treatment records that have not been sought or obtained. Specifically, he states he was treated for his claimed conditions at Memphis VAMC from 1956-1957; Poplar Bluff VAMC; and John Cochran (St. Louis) VAMC. It is unclear what dates he was treated at Poplar Bluff and on remand the Veteran should be asked to identify the approximate dates of treatment at that facility. The Veteran states that due to his age he simply cannot recall the precise dates of his treatment in the 1950s, but he knows he was treated for his back with injections and traction at John Cochran just weeks after it opened, and again a year later. That facility opened in 1954, which is approximately the time the Veteran states he was treated there, and the March 1954 application for VA hospital treatment mentioned above appears to have been prepared at the Cochran facility. Therefore, a remand is necessary to attempt to physically or electronically obtain these treatment records. Finally, the Veteran was afforded a VA neurological examination in July 2010 with an addendum in August 2010. The July 2010 medical opinion states that the Veteran had documented left foot numbness in service but its etiology is not clear and cannot be resolved without mere speculation. However, the examiner goes on to state that the left foot numbness is unlikely to be caused by back problems. An examiner's report that he or she cannot provide an opinion without resort to speculation is inadequate unless the examiner provides a rationale for that statement. See Jones v. Shinseki, 23 Vet. App. 382 (2010). As such, if the examiner is unable to offer an opinion, it is essential that the examiner provide a rationale for the conclusion that an opinion could not be provided without resort to speculation, together with a statement as to whether there is additional evidence that could enable an opinion to be provided or whether the inability to provide the opinion is based on the limits of medical knowledge. The August 2010 medical opinion stated that the diagnosed chronic problems of extensive osteophytosis and DDD of the lumbar spine are "more likely secondary to lifestyle as opposed to the active duty injury." No rationale is provided for this opinion. As there may be outstanding treatment records and the existing medical opinions lack an adequate rationale, it is necessary to obtain a new medical opinion that addresses whether the Veteran's current left leg and lumbar spine disabilities are related to service, including the documented in-service complaints and/or spinal anesthesia used during the in-service inguinal hernia repair. Accordingly, the case is REMANDED for the following actions: (Please note, this appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2012). Expedited handling is requested.) 1. Ask the Veteran to identify the approximate dates (or years) that he received treatment for his lumbar spine and/or left leg symptoms at Poplar Bluff VAMC. Obtain any identified treatment records, physically or electronically. 2. Obtain treatment records that are relevant to lumbar spine and/or left leg symptoms, physically or electronically, from a) Memphis VAMC dated from January 1956 to December 1957; and b) John Cochran (St. Louis) VAMC dated March 1954 to December 1956. All efforts made should be documented in the claims file. If no relevant records exist, then the claims file should be annotated to reflect such and the Veteran notified. 3. After associating any outstanding records with the claims file, schedule the Veteran for an appropriate VA evaluation to determine the nature and etiology of his left leg and lumbar spine symptoms. The claims file must be made available and reviewed by the evaluator. Any indicated studies should be performed. The evaluator should first identify the Veteran's current left leg and lumbar spine diagnoses. Then, for each diagnosis, state whether it is at least as likely as not that a) the disability initially manifested in service; b) the disability is causally related to his service or was manifested within one year of discharge from service (by September 1952); c) the disability was caused or aggravated by the April 1951 inguinal hernia repair surgery, to include the documented use of spinal anesthesia. The evaluator should also acknowledge and discuss the statements of the Veteran as to the continuity of symptomatology of his leg and lumbar spine symptoms since service. The evaluator should discuss the documented in-service symptoms of transient hypolgesia and analgesia with lumbar and partial sacral involvement, motor and sensory defects in the left foot, and stocking anesthesia. The evaluator should describe all findings in detail and provide a complete rationale for all opinions offered. If the evaluator is unable to provide the requested opinions without resort to speculation, the reasons for that should be explained, noting particularly whether it is the limits of medical knowledge that prevents providing the opinion or missing facts. If it is missing facts, the information that is necessary to provide a non-speculative opinion should be described to the extent possible. 4. Then, readjudicate the Veteran's claims. If action remains adverse, he should be provided with a supplemental statement of the case and allowed an appropriate opportunity to respond. Thereafter, the case should be returned to the Board. The Veteran has the right to submit additional evidence and argument on the matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). These claims must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board 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). _________________________________________________ MICHAEL E. KILCOYNE 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).