Citation Nr: 18145448 Decision Date: 10/29/18 Archive Date: 10/29/18 DOCKET NO. 96-05 310A DATE: October 29, 2018 REMANDED Entitlement to service connection for a low back disorder, to include as secondary to a service-connected psychiatric disorder is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Air Force from April 1970 to April 1972. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a June 1999 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). By way of history, the Board initially denied the claim on appeal in a February 2000 decision. The Veteran appealed the Board decision to the United States Court of Appeals for Veterans Claims (Court). In a November 2000 Order, the decision was vacated, pursuant to a Joint Motion for Remand (JMR). The Board denied the claim again in a January 2006 decision. The Veteran again appealed the Board decision to the Court which vacated the decision pursuant to a JMR in January 2008. Following further development, the Board denied the claim in a March 2014 decision. The Veteran appealed the Board decision to the Court, and in an April 2015 Memorandum Decision, the Court vacated the decision. Following remands for further development in December 2015, May 2016, and in April 2017, the Board denied the claim in September 2017. The Veteran again appealed the Board decision to the Court. In a June 2018 Order, pursuant to a September 2017 JMR, the Court vacated the Board decision and remanded the claim for action consistent with the terms of the JMR. 1. Entitlement to service connection for a low back disorder, to include as secondary to a service-connected psychiatric disorder is remanded. In the September 2017 JMR, the parties determined that the Board erred when it found substantial compliance with its May 2016 and April 2017 remand directives. In the May 2016 remand, the Board instructed the VA examiner, who provided the February 2016 opinion, to determine whether the Veteran’s low back disorder was caused or aggravated by his service-connected chronic psychoneurotic anxiety reaction disorder, and to consider the July 1995 and August 1999 VA mental disorder opinions of record. In a post-remand addendum opinion received in September 2016 that VA examiner indicated she was unable to provide the requested opinion because she was not qualified to do so. Thus, in the April 2017 remand, the Board ordered an opinion addressing secondary service connection, this time by a “qualified VA examiner.” Pursuant to the April 2017 remand, an opinion addressing secondary service connection was obtained in July 2017. However, the opinion only addressed direct causation and was provided by the February 2016 VA examiner who previously reported she was not qualified to provide such an opinion. With regards to aggravation, the examiner again reported that she was not qualified to make conclusions about the Veteran’s service-connected psychiatric disorder. In addition, the examiner did not comment on the July 1995 or August 1999 VA mental disorder opinions as required by the remand instructions. Given these deficiencies, the Board finds there has not been substantial compliance with the Board’s May 2016 and April 2017 remand directives, and a new medical opinion addressing secondary service connection is required. Stegall v. West, 11 Vet. App. 268 (1998). The matter is REMANDED for the following action: 1. Obtain the Veteran’s VA treatment records for the period from April 2017 to the present. 2. Obtain a VA medical opinion regarding the etiology of the Veteran’s low back condition from a qualified medical professional (i.e. an examiner other than the responding examiner in September 2016 and July 2017). The need for a physical examination is left to the discretion of the VA examiner. The examiner must review the entire claims file and a copy of this Remand. 3. The examiner is asked to opine whether it is at least as likely as not that the Veteran’s low back disorder is either a) caused by OR, b) aggravated by his service-connected psychiatric disorder. The examiner is advised that two opinions are required: one for proximate causation and a second for aggravation. The term “aggravation” means a chronic worsening of a disability beyond its natural progression. If aggravation is found, then, to the extent possible, the examiner should establish a baseline level of severity of the low back condition prior to aggravation by the service-connected psychiatric disorder. In providing the requested opinions, the examiner must consider and discuss the July 1995 and August 1999 VA mental disorder opinions which indicate that the Veteran’s low back symptoms might represent a conversion disorder and that the Veteran had a neurotic skeletal disorder consistent with chronic psychoneurotic anxiety reaction. All opinions must be thoroughly explained, and an adequate rationale must be provided for all opinions and conclusions expressed. In doing so, the examiner should address any conflicting evidence of record. Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD E. Mortimer, Associate Counsel