Citation Nr: 18140491 Decision Date: 10/04/18 Archive Date: 10/03/18 DOCKET NO. 15-14 326 DATE: October 4, 2018 REMANDED Entitlement to service connection for a back disability is remanded. Entitlement to service connection for a neurological disorder of the upper extremities is remanded. Entitlement to service connection for a neurological disorder of the lower extremities is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from January 1968 to May 1968, with additional Oklahoma Army National Guard service. This matter comes before the Board of Veterans’ Appeals (Board) from a January 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Muskogee, Oklahoma. In June 2018, the Veteran testified before the undersigned Veterans Law Judge. The Veteran asserts his back disability and neurological disorders had their onset in service following multiple field artillery trainings with the Oklahoma Army National Guard. More specifically, he reports having back problems after lifting artillery shell boxes, moving trailers from trucks, and performing the trails grounding process. See May 2013 Statement in Support of Claim; June 2018 Board Hearing Transcript, pgs. 9-11, 23. Even though the Veteran acknowledges that he did not report to sick call during field trainings, he states that he began chiropractic treatment for his back and nerve pain located in his arms and legs towards the end of his service with the National Guard, and that the chiropractor advised that he had a bulging disc. See Board Hearing Transcript at pgs. 11-12, 15-6, 22-23. Further, the Veteran asserts that his neuropathy symptoms may be a result from a Line of Duty (LOD) tick bite injury that resulted in Rocky Mountain spotted fever. See July 1969 Line of Duty Determination; June 2018 Board Hearing Transcript, pgs. 17, 21. In this regard, the Veteran’s representative has submitted two medical journal abstracts discussing an association between Rocky Mountain spotted fever and peripheral neuropathy and arthritis. See July 2018 Veteran’s Statement of Accredited Representative in Appealed Case. Given the Veteran’s in-service tick bite, his lay statements alleging back and neurological symptoms during service and the evidence of record of current disabilities, the duty to obtain a VA examination is triggered. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). All outstanding post-service treatment records should also be secured on remand. The matters are REMANDED for the following action: 1. Obtain all outstanding VA treatment records. 2. With any necessary assistance from the Veteran, obtain all outstanding relevant private treatment records, to include updated records from Dr. Remondino. 3. Thereafter, schedule the Veteran for a VA examination to determine the nature and etiology of his back disability. The entire claims file must be made available to and reviewed by the examiner. The examiner should opine whether it is at least as likely as not (50 percent probability or more) that any current back disability had its onset during his active duty or National Guard service or is otherwise related to an injury from the cumulative impact of his duties during his active duty and National Guard service. In addressing this question, the examiner must discuss: (1) the Veteran’s lay statements as to his duties of Cannoneer and Gunner and the specific trails grounding process performed at the annual field trainings per the June 2018 Board hearing at pages 9-11; and (2) the Veteran’s statement as to unreported back pain during service and that a chiropractor advised that he had a bulging disc toward the end of his National Guard service. The examiner should provide a complete rationale for any opinion rendered, and cannot rely solely on the absent of documentation in the Veteran’s service records. If the examiner rejects the Veteran’s lay reports, the examiner must provide a reason for doing so. If the examiner cannot provide the requested opinion without resorting to speculation, he or she should expressly indicate this and provide a supporting rationale as to why an opinion cannot be made without resorting to speculation. 4. Schedule the Veteran for a VA examination to determine the nature and etiology of any neurological disorders of the upper and lower extremities. The entire claims file must be made available to and reviewed by the examiner. The examiner should opine whether it is at least as likely as not (50 percent probability or more) that any current neurological disorder of the upper and lower extremities: (a) (1) had its onset during his active duty or National Guard service, (2) is the result of the Veteran’s tick bite injury; or (3) is otherwise related to an injury from the cumulative impact of his duties during his active duty and National Guard service. In addressing this question, the examiner must discuss: the Veteran’s lay statements as to his duties of Cannoneer and Gunner and the specific trails grounding process performed at the annual field trainings per the June 2018 Board hearing at pages 9-11; the Veteran’s statement as to unreported nerve pain during service; and the two medical journal abstracts discussing an association between Rocky Mountain spotted fever and peripheral neuropathy and arthritis submitted in July 2018. (b) If the answer to question (a) is unfavorable and a back disability is also service-connected as a result of these remand directives, the examiner should opine as to whether it is at least as likely as not (50 percent probability or more) that any current neurological disorder of the upper and lower extremities is: (1) proximately due to or (2) aggravated (worsened beyond natural progression) by the Veteran’s back disability. Please address (b)(1) and (b)(2) separately. The examiner should provide a complete rationale for any opinion rendered and cannot rely solely on the absent of documentation in the Veteran’s service records. If the examiner rejects the Veteran’s lay statements, the examiner must provide reasons for doing so. If the examiner cannot provide the requested opinion without resorting to speculation, he or she should expressly indicate this and provide a supporting rationale as to why an opinion cannot be made without resorting to speculation. S. BUSH Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Victoria L. Stephens, Associate Counsel