Citation Nr: 18144460 Decision Date: 10/25/18 Archive Date: 10/24/18 DOCKET NO. 14-36 428 DATE: October 25, 2018 REMANDED Entitlement to service connection for a low back disability is remanded. Entitlement to service connection for a neck disability is remanded. Entitlement to service connection for radiculopathy is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1974 to September 1994. The matters come before the Board of Veterans’ Appeals (Board) on appeal from Department of Veterans Affairs (VA) Regional Office (RO) rating decisions made in June 2012, November 2013, and May 2015 that denied service connection for a low back disability, a neck disability, and radiculopathy. The Board notes that the Veteran did not respond within 30 days of the hearing clarification letter sent to him on July 3, 2018. In accordance with the terms of the letter, the Board will presume that the Veteran does not wish to attend a hearing as indicated on his February 2018 Form 9.   FACTUAL BACKGROUND The Veteran suffered an injury to his right shoulder lifting a heavy paint can while in service on February 9, 1994, for which he is service-connected. The Veteran claims that his low back disability, neck disability, and radiculopathy stem from the same incident. The Veteran also claims service connection on a secondary basis, alleging that his right shoulder injury “forced [him] to compensate and overuse [his] left shoulder to the detriment of [his] neck.” A private medical practitioner, Dr. Wittenberg, opined in October 2011 that the Veteran’s current symptoms of back pain “are similar to those of 1994,” and that “it is possible that his current medical conditions are one and the same as that cared for during his military service.” No rationale was given for the opinion. In August 2010, Hampton VA Medical Center (VAMC) noted “low back onset 2/01/94,” indicating onset during service. After reviewing the Veteran’s entire military record file, Dr. Kirven, a private medical practitioner, opined in September 2013 that the Veteran “most likely sustained a traumatic injury to the cervical spine in 1994.” Dr. Kirven did not support his medical opinion with a rationale. An MRI scan of the Veteran’s cervical spine showed “severe foraminal stenosis” in the cervical spine, and an EMG nerve conduction study showed “left subacute C6-7 radiculopathy.” The March 2014 VA examiner opined that the Veteran’s back injury, diagnosed as lumbosacral paraspinal tendonitis, is less likely than not incurred in or caused by the claimed in-service injury, event, or illness, and cited the lack of in-service treatment records as his rationale. The examiner did not provide an etiological opinion. The December 2017 VA examiner opined that the Veteran’s cervical strain and osteoarthritis with bilateral radiculopathy was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The rationale was that there were no medical records of cervical pain while the Veteran was in service. The examiner did not address Dr. Kirven’s opinion that the Veteran “most likely sustained a traumatic injury to the cervical spine in 1994,” or provide an etiological opinion. Entitlement to service connection for low back disability, neck disability, and radiculopathy, claimed as secondary to service-connected right shoulder disability, are remanded. VA examinations show that the Veteran currently has a low back disability, a neck disability, and radiculopathy. He stated that he injured his back and neck when he injured his right shoulder, and private practitioners opined that the Veteran’s disabilities could have been caused by his in-service injury to his right shoulder. However, the medical evidence, private or otherwise, are insufficient as the private practitioners did not support their opinions with substantial or adequate reasoning and justifications, and the VA examiners did not provide a sufficient etiological opinions, only citing the lack of treatment in service and failing to consider the Veteran’s competent reports of pain since the in-service injury. See Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006); see also Barr v. Nicholson, 21 Vet. App. 303 (2007). The Board cannot make a fully-informed decision on the above issues of entitlement to service connection for low back disability, neck disability, and radiculopathy, as there are no sufficient medical opinions on record that provide substantial or adequate reasoning or justifications supporting their conclusions. The matter is REMANDED for the following action: 1. Afford the Veteran an examination to determine the nature and etiology of his low back, neck and radiculopathy disabilities. Access to the Veteran’s electronic claims file should be made available to the examiner for review in connection with the examination. After examining the Veteran and the record, and taking his medical history, the examiner should provide an opinion, with supporting rationale, as to whether it is at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran’s low back, neck and radiculopathy disabilities were incurred during his period of service from September 1974 to September 1994, or are otherwise related to that period of service, including the February 1994 incident in which the Veteran injured his right shoulder. If the answer to the foregoing question is no, the examiner should provide an opinion, with supporting rationale, as to whether it is at least as likely as not that any current low back, neck, or radiculopathy disability is: (1) proximately due to the service-connected right shoulder disability, or (2) aggravated beyond the natural progression by the service-connected right shoulder disability.   In rendering an opinion, the examiner must discuss the relevant evidence of record, including the Veteran’s lay statements regarding the onset of the claimed disability and the October 2011 and September 2013 private medical opinions referenced above. K. Conner Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD H. Yun, Associate Counsel