Citation Nr: 18140741
Decision Date: 10/05/18	Archive Date: 10/05/18

DOCKET NO. 16-22 367
DATE:	 
REMANDED
Entitlement to service connection for a back condition, to include as secondary to service-connected degenerative arthritis of the right and left knees, is remanded.
REASONS FOR REMAND
The Veteran served on active duty from April 1979 to April 1983.
This case comes before the Board of Veterans’ Appeals (Board) on appeal from a July 2013 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO).
1. Entitlement to service connection for a back condition is remanded.
At the outset, the Board notes that the Veteran has claimed in an April 2014 statement that she has received private treatment by Dr. Crawford for her back disability as relating to her knees.  These records are not in the claims folder; therefore, these records should be obtained and associated with the claims folder.  
The Veteran has a current diagnosis of degenerative joint disease of the lumbar spine.  The Veteran has claimed that such is due to service and her service treatment records (STRs) reflect that she incurred cervical spine strain due to an in-service January 1983 motor vehicle accident and that she thereafter reported recurrent back pain at a Report of Medical History in January 1983.  
The Veteran was afforded a VA examination for her back condition in September 2015.  After a thorough examination of the Veteran, the examiner indicated that the Veteran’s back condition existed prior to service, by opining that her back condition has been aggravated beyond its natural progression.  The examiner then provided a secondary opinion relating to the Veteran’s knees, finding it less likely than not that the Veteran’s low back condition is due to or related to her knee condition, but then in the rationale stated that the knee condition can aggravate the back condition.  
The Board finds this September 2015 opinion to be internally conflicting and inconsistent.  On remand, the Veteran should be afforded a new VA examination and opinion to determine the nature and etiology of her current back disability, addressing her motor vehicle accident and complaints of back pain in service.  The examiner should also specifically address any relationship the Veteran’s back disability has to her service-connected bilateral knee disability.  
The matter is REMANDED for the following action:
1. Obtain any outstanding VA treatment records.
2. Afford the Veteran an opportunity to submit records, or provide an appropriate release for records, pertaining to her treatment for her back disability by Dr. Crawford.
3. After any additional records are associated with the claims file, provide the Veteran with an appropriate examination to determine the etiology of any diagnosed back disability.  The entire claims file must be made available to and be reviewed by the examiner.  Any indicated tests and studies must be accomplished and all clinical findings must be reported in detail and correlated to a specific diagnosis.  An explanation for all opinions expressed must be provided.  
The examiner must opine regarding whether it is at least as likely as not (50 percent or greater probability) that any back disorder had its onset in, or is otherwise related to, the Veteran’s military service, including consideration of her 1983 motor vehicle accident and her 1983 report of medical history indicating recurrent back pain.  
The examiner should also address whether it is at least as likely as not that any diagnosed back disorder was (1) caused or (2) aggravated by her service-connected arthritis of the bilateral knees.  
The examiner should provide a clear rationale for each opinion provided.  

 
S. HENEKS
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	N. Kamal, Associate Counsel