Citation Nr: 18146746 Decision Date: 11/01/18 Archive Date: 11/01/18 DOCKET NO. 15-43 642 DATE: November 1, 2018 ORDER Service connection for high cholesterol is denied. Service connection for an acquired psychiatric disability is denied. Service connection for shin splints is denied. Service connection for an eye disorder is denied. REMANDED Entitlement to service connection for tinnitus is remanded. Entitlement to service connection for a bilateral foot disorder is remanded. Entitlement to service connection for a cervical spine disorder is remanded. Entitlement to service connection for a skin disorder is remanded. Entitlement to service connection for a left ankle disorder is remanded. Entitlement to service connection for a right knee disorder is remanded. Entitlement to service connection for a low back disorder is remanded. Entitlement to service connection for a sciatic nerve disorder, to include as due to low back disorder, is remanded. FINDINGS OF FACT 1. The Veteran’s current diagnosis of hyperlipidemia is a laboratory finding, and is not, by itself, a ratable disability according to VA regulations. 2. The Veteran has not been shown to have a current diagnosis of an acquired psychiatric disability or shin splints at any time since separation from service in June 1985. 3. The Veteran has not been shown to have a current disorder, functional impairment, or superimposed disease or injury attributable to myopic presbyopia at any time since separation from service in June 1985. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for high cholesterol have not been met. 38 U.S.C. § 1131 (2012); 38 C.F.R. §§ 3.303, 4.1 (2018). 2. The criteria for entitlement to service connection for an acquired psychiatric disability have not been met. 38 U.S.C. §§ 1131; 38 C.F.R. § 3.303. 3. The criteria for entitlement to service connection for shin splints have not been met. 38 U.S.C. §§ 1131; 38 C.F.R. § 3.303. 4. The criteria for entitlement to service connection for an eye disorder have not been met. 38 U.S.C. § 1131; 38 C.F.R. §§ 3.303, 4.9 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Air Force from October 1980 to June 1985. The Board has recharacterized the Veteran’s claims for depression, vision impairment, fallen arches, degenerative arthritis disk disease, skin lesions, bulging disk L1-2, and herniated disk L4-5 more broadly to an acquired psychiatric disability, an eye disorder, bilateral foot disorder, cervical spine disorder, skin disorder, and low back disorder in order to clarify the nature of the benefits sought and ensure complete consideration of the claims. Clemons v. Shinseki, 23 Vet. App. 1, 5-6, 8 (2009). Neither the Veteran nor her representative have raised any issues with the duty to notify or duty to assist. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board... to search the record and address procedural arguments when the veteran fails to raise them before the Board.”); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). Service Connection Service connection may be established for disability resulting from personal injury suffered or disease contracted in line of duty in the active military, naval, or air service. 38 U.S.C. § 1131. Service connection may be granted for any injury or disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303(d). 1. High cholesterol In a February 2012 VA Form 21-0820 (Report of General Information), the Veteran requested service connection, in part, for high cholesterol. Upon VA Disability Benefits Questionnaire (DBQ) examination for heart conditions in December 2013, the VA examiner concluded no heart condition was found or evidence of any high cholesterol related condition in service treatment records. Review of VA treatment records shows the Veteran was notified in June 2013 that her test results revealed elevated cholesterol levels and hyperlipidemia was listed among her active problem list in December 2013. Hyperlipidemia is defined as “a general term for elevated concentration of any or all of the lipids in the plasma.” DORLAND’S ILLUSTRATED MEDICAL DICTIONARY, 903 (31st ed. 2007). As such, the Board finds that hyperlipidemia represents only a laboratory finding and not an actual disability in and of itself for which VA compensation benefits are payable. See 61 Fed. Reg. 20440, 20445 (May 7, 1996). The United States Court of Appeals for Veterans Claims has held that “Congress specifically limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability”. See 38 U.S.C. § 1131. In the absence of proof of a present disability there can be no valid claim.” See Degmetich v. Brown, 104 F. 3d 1328 (1997). Applicable VA regulations use the term “disability” to refer to the average impairment in earning capacity resulting from diseases or injuries encountered as a result of or incident to military service. Allen v. Brown, 7 Vet. App. 439 (1995); 38 C.F.R. § 4.1. The Board has considered the Veteran’s reported high cholesterol throughout the appeal period and in her Form 9 has attributed “all” her disabilities to an in-service motor vehicle accident. She is competent to report that she has been informed of her high cholesterol. Layno v. Brown, 6 Vet. App. 465, 470 (1994). However, the Veteran has not reported any subjective, observable symptoms from her high cholesterol to indicate that she has functional impairment or disability from this condition. In summary, there must be competent evidence of a current disability to support service connection, and an abnormality, such as hyperlipidemia, does not of itself constitute disease or disability. Because hyperlipidemia is not a disease or disability for which service connection may be granted on a direct basis, the claim must be denied. 2. Acquired psychiatric disability 3. Shin splints Due to the similar dispositions for the claims on appeal, the Board will address them in a common discussion below. In July 2012 and April 2014 statements, the Veteran requested service connection for depression. Review of VA treatment records shows negative results from depression screenings in June 2010, September 2011, and April 2013; and from a posttraumatic stress disorder (PTSD) screening in June 2010. For all four of these screening, she responded in the negative to each question, versus in the positive, which would have indicated the presence of symptoms. The record notes that she was part of a VA smoking cessation program, and in a September 2011 record, it was noted that she had “slightly flattened affect” but was “otherwise well-related." Her medical records were otherwise negative for any psychiatric symptoms or diagnoses of a psychiatric condition. In the February 2012 VA Form 21-0820 and July 2012 statement, the Veteran requested service connection, in part, for bilateral shin splints. The Board acknowledges that review of the Veteran’s service treatment records documents shin splints in October 1980 and November 1980, and an August 2016 private DBQ examination for back (thoracolumbar spine) conditions notes an in-service diagnosis of shin splints in October 1980. Nevertheless, review of VA treatment records is silent for any current findings or diagnosis for shin splints, and following clinical evaluation at the December 2013 VA DBQ examinations for ankle conditions and knee and lower leg conditions, the VA examiner concluded there were no clinical findings of shin splints. Based on the evidence of record, there is no probative and competent evidence that demonstrates a current disability during the appeal period. See 38 U.S.C. § 1131; 38 C.F.R. § 3.303. As a result, the Board finds that the record does not contain a current disability to establish that the first criterion to establish service connection on a direct basis has been met. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992) (“Congress specifically limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability,” and held that “[i]n the absence of proof of a present disability[,] there can be no valid claim.”); Rabideau v. Derwinski, 2 Vet. App. 141, 143-44 (1992). The most probative evidence of record reflects the Veteran has not been shown to have a current diagnosis of an acquired psychiatric disability or shin splints at any time since separation from service in June 1985. The Board has considered the Veteran’s reported depression and shin splints throughout the appeal period. See Layno, 6 Vet. App. at 470. Her reports of subjective feelings of depression and shin pain are also credible. Because there is no universal rule as to competence on this issue, the Board must determine on a case-by-case basis whether a particular condition is the type of condition that is within the competence of a lay person to provide an opinion as to its existence or etiology. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24 Vet. App. 428 (2011). She has stated in her Form 9 that “all” of her claimed disabilities are due to her in-service MVA. However, upon clinical screening, no diagnosis of an acquired psychiatric disability or shin splints was provided. She does not have the training or medical experience to self-diagnose a psychiatric disorder. Further, VA examiners have specifically found that she does not have shin splints. The findings of a VA clinician are more probative as the lack of shin splints was determined during orthopedic examinations which specifically intended to determine whether shin splints were present. Additionally, she has not provided a lay description of her shin-related symptoms and how they cause functional impairment. Therefore, her assertions are of less probative value than the medical evidence. For these reasons, service connection for a psychiatric disorder and shin splints is denied. In reaching this decision the Board considered the doctrine of reasonable doubt, however, as the preponderance of the evidence is against these claims, the doctrine is not for application. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 4. Eye disorder In the February 2012 VA Form 21-0820, the Veteran requested service connection, in part, for vision impairment. At the December 2013 VA DBQ examination for eye conditions, the Veteran asserted reduced vision due to increased refractive error caused by a lot of reading she did while in active service. Following the clinical evaluation, the VA examiner concluded the Veteran does not have or has ever been diagnosed with an eye condition (other than congenital or development errors of refraction) and rendered an impression of myopic presbyopia. At the outset, the Board acknowledges that error of refraction or refractive error is defined as “deviation from optimal focusing of light (emmetropia) by the lens of the eye onto the retina, such as myopia, hyperopia, astigmatism, or anisometropia.” DORLAND’S ILLUSTRATED MEDICAL DICTIONARY, 649 (31st ed. 2007). Additionally, presbyopia is defined as “hyperopia and impairment of vision due to advancing years or to old age.” Id. at 1534. Congenital or developmental defects are not diseases or injuries within the meaning of the applicable legislation. 38 C.F.R. §§ 3.303(c), 4.9. VA’s General Counsel has further explained that service connection may be granted for diseases (but not defects) of congenital, developmental or familial origin, as long as the evidence as a whole establishes that the familial conditions in question were incurred or aggravated during service within the meaning of VA laws and regulations. VAOPGCPREC 82-90 (July 18, 1990). VA’s General Counsel has also expressly stated that the terms “disease” and “defects” must be interpreted as being mutually exclusive. The term “disease” is broadly defined as any deviation from or interruption of the normal structure or function of any part, organ, or system of the body that is manifested by a characteristic set of symptoms and signs and whose etiology, pathology, and prognosis may be known or unknown. On the other hand, the term “defects” would be definable as structural or inherent abnormalities or conditions that are more or less stationary in nature. See VAOPGCPREC 82-90 (July 18, 1990). However, VA General Counsel has further noted that if, during service, superimposed disease or injury occurs, service connection may be warranted for the resultant disability. See Jensen v. Brown, 4 Vet. App. 304, 306-307 (1993) (citing Hunt v. Derwinski, 1 Vet. App. 292 (1991)); VAOPGCPREC 67-90 (July 18, 1990). Based on the evidence of record, there is no probative and competent evidence that demonstrates a current disability during the appeal period. See 38 U.S.C. § 1131; 38 C.F.R. § 3.303. As a result, the Board finds that the record does not contain a current disability to establish that the first criterion to establish service connection on a direct basis has been met. See Brammer, 3 Vet. App. at 225; Rabideau, 2 Vet. App. at 143-44. The most probative evidence of record reflects the Veteran has not been shown to have a current diagnosis, functional impairment of earning capacity, or superimposed disease or injury attributable to myopic presbyopia at any time since separation from service in June 1985. The Board has considered the Veteran’s reported history of symptomatology related to this claimed eye disorder throughout the appeal period. See Layno, 6 Vet. App. at 470. Because there is no universal rule as to competence on this issue, the Board must determine on a case-by-case basis whether a particular condition is the type of condition that is within the competence of a lay person to provide an opinion as to its existence or etiology. See Jandreau, 492 F.3d at 1376-77; see also Kahana, 24 Vet. App. at 428. In this case, the Veteran’s reports of vision impairment and reduced vision are competent and credible; however, upon clinical evaluation, no diagnosis, functional impairment, or superimposed disease or injury was noted attributable to these symptoms and the Veteran has not submitted a lay description of functional impairment of earning capacity caused by such reported symptomatology, nor has she provided lay evidence in support of a finding that a superimposed disease or injury occurred. Therefore, her assertion is of less probative value than the medical evidence. In reaching this decision the Board considered the doctrine of reasonable doubt, however, as the preponderance of the evidence is against this claim, the doctrine is not for application. Gilbert, 1 Vet. App. at 49. REASONS FOR REMAND 1. Entitlement to service connection for tinnitus In the April 2014 statement, the Veteran requested service connection for tinnitus. In the November 2015 VA Form 9, she also reported that all issues on appeal, to include tinnitus, started while in service. Review of the Veteran’s service treatment records indicates some degree of noise exposure therein, as evidence by a positive threshold shift from the time of entry to separation from service at the 500 Hertz range. Specifically, at the October 1980 entrance examination, her bilateral pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 5 10 10 10 30 LEFT 5 5 5 5 10 At the February 1985 separation examination, her bilateral pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 15 5 0 0 10 LEFT 10 0 0 5 5 As a result, the Board finds that additional development is needed to determine the etiology of tinnitus on a direct basis. 38 U.S.C. § 5103A(a) (2012); 38 C.F.R. §§ 3.159, 3.303 (2018); McLendon v. Nicholson, 20 Vet. App. 79 (2006). 2. Entitlement to service connection for a bilateral foot disorder In the February 2012 VA Form 21-0820, the Veteran requested service connection, in part, for bilateral fallen arches. Review of VA treatment records show reported pain in the right foot in October 2011 and pain in the left arch with walking in September 2013. During the course of the appeal, the Veteran was afforded a VA DBQ examination for foot miscellaneous (other than flatfoot/pes planus) in December 2013. She reported injury to her feet while in service due to physical training and occasional pain in her feet throughout service. In her Form 9, she also stated that “all” her disabilities were due to her in-service motor vehicle accident. Following the clinical evaluation, the VA examiner concluded “normal examination at present time.” In light of the Veteran’s reported symptomatology regarding her arches during the appeal period, the Board finds that an additional VA examination for flatfoot/pes planus is needed to properly adjudicate this claim at this time. When VA undertakes to provide a VA examination or medical opinion, it must ensure that it is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). 3. Entitlement to service connection for a cervical spine disorder Review of service treatment records shows that in April 1982 the Veteran reported neck pain, being in a car accident two days prior, and was assessed with cervical strain secondary to the motor vehicle accident. During the appeal period, the Veteran was afforded a VA DBQ examination for neck (cervical spine) conditions in December 2013. Following the clinical evaluation, the VA examiner concluded “normal neck examination at present with no pain or dysfunction at present time,” so no medical opinion was necessary. Nevertheless, a June 2012 VA treatment record shows that review of a May 2012 private treatment record documents a diagnosis of cervical strain. As such, the Board finds that a VA medical opinion is needed to determine the etiology of a cervical spine disorder on direct basis. See 38 U.S.C. § 1131; 38 C.F.R. § 3.303; McLendon, 20 Vet. App. at 79. 4. Entitlement to service connection for skin disorder During the appeal period, the Veteran was afforded a VA DBQ examination for skin diseases in December 2013. Following the clinical evaluation, the VA examiner rendered a current diagnosis of warts and opined that the “claimed wart condition is less likely than not incurred in or caused by the claimed in-service injury, event, or illness” because review of service treatment records did not include any mention of vaginal warts. In contrast, review of the Veteran’s service treatment records documents gynecology treatment for warts on the labia in November 1984. As a result, the Board finds the VA examiner’s rationale is based on an inaccurate factual history and that an addendum VA medical opinion is needed to properly adjudicate this claim at this time. See Barr, 21 Vet. App. at 312. Additionally, the Veteran reported at the December 2013 VA DBQ examination for skin diseases that she had two warts removed from the right upper arm in July 2013 by a private dermatologist and had another similar wart removed from the left forearm in 2010. She also asserted that these warts are connected to her claimed vaginal warts. As of this date, review of the record is silent for an attempt to obtain the records from the private dermatologist. As such, a remand is needed to obtain these identified outstanding potentially relevant private treatment records. See Sullivan v. McDonald, 815 F.3d 786, 793 (Fed. Cir. 2016) (citing 38 C.F.R. § 3.159(c)(3) (2018)). 5. Entitlement to service connection for left ankle disorder 6. Entitlement to service connection for right knee disorder 7. Entitlement to service connection for low back disorder Due to the similar dispositions for the claims on appeal, the Board will address them in a common discussion below. During the appeal period, the Veteran was afforded VA DBQ examinations for ankle conditions, knee and lower leg conditions, and back (thoracolumbar spine) conditions in December 2013. Following the examinations, the VA examiner rendered diagnoses of bilateral ankle sprain, degenerative joint disease (DJD) of knees and lumbar spine, mild residual back sprain, and herniated disc of back, and concluded “[t]he Veteran’s [bilateral ankles conditions, bilateral knee conditions, and back conditions] not caused by or a result of injury during the service. I cannot resolve this issue without resort to mere speculation.” It was explained that the February 1985 separation examination report showed normal findings and medical history and present medical examination confirmed the rationale. The Board finds that this medical opinion was provided using the incorrect evidentiary standard for determining whether service connection is warranted on a direct basis. Moreover, if the examiner was unable to provide an opinion without resorting to mere speculation, the rationale provided did not include consideration of the documented in-service pain in ankles and knees in November 1980, emergency room care for right leg injury and soft tissue injury after motor vehicle accident in April 1982, and treatment for low back pain in August 1982. As a result, the Board finds that addendum VA medical opinions are needed to properly adjudicate these claims at this time. See Barr, 21 Vet. App. at 312. Next, the Board notes that the Veteran identified private treatment records from the Einstein Medical Facility in the February 2012 VA Form 21-0820. In the January 2013 VA Form 21-526, she also identified private treatment records from Personal Health Rehabilitation with Dr. Kosmorsky, Cypress Rehabilitation from Dr. Yarius, and Fountain Medical from Dr. Shabazz. In a March 2013 notice letter, the Veteran was requested, in part, to complete a VA Form 21-4142 in order for VA to contact and request treatment records from providers she identified in the January 2013 VA Form 21-526. In an October 2013 notice letter, she was also requested, in part, to complete a VA Form 21-4142 in order for VA to contact and request treatment records from the facility she identified in the February 2012 VA Form 21-0820. As of this date, the Veteran has yet to respond to these requests. But as the case is already being remanded, she should be provided with the release forms again. Lastly, a June 2012 VA treatment record documents that private treatment records were reviewed from the Chiropractic Rehabilitation and Wellness Center LLC with Dr. Diana Louca for thoracic spine/strain, lumbosacral radiculitis, and knee pain; however, review of the record is silent for an attempt to obtain these records. As such, a remand is needed to obtain these identified outstanding potentially relevant private treatment records. See Sullivan, 815 F.3d at 793 (citing 38 C.F.R. § 3.159(c)(3)). 8. Entitlement to service connection for sciatic nerve disorder, to include as due to low back disorder While the Board remands the issue of entitlement to service connection for low back disorder for additional evidentiary development, as discussed above, that decision may impact this claim for service connection for sciatic nerve disorder. As such, these issues are inextricably intertwined. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). The matters are REMANDED for the following actions: 1. Contact the Veteran and request that she identify any private treatment facilities or providers for her skin, right knee, and low back disorders and provide her with the appropriate release forms. Then, if she provides the required information, make appropriate efforts to obtain any outstanding records so authorized for release from any facility identified by the Veteran, to include as identified in the December 2013 VA DBQ examination for skin diseases and the Chiropractic Rehabilitation and Wellness Center LLC with Dr. Diana Louca as identified in a June 2012 VA treatment record. If these records cannot be located, the Regional Office (RO) must specifically document the attempts made to locate them and notify the Veteran. 2. Schedule the Veteran for an examination with an appropriate clinician for her tinnitus. The entire claims file and a copy of this remand must be made available to the examiner for review. Although an independent review of the claims file is required, the Board calls the examiner’s attention to the following: Service treatment records indicates some degree of noise exposure therein, as evidence by a positive threshold shift from the time of entry to separation from service at the 500 Hertz range. The examiner must provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s tinnitus began during active service, is related to an incident of service, to include in-service noise exposure, or began within one year after discharge from active service. The examiner must provide all findings, along with a complete rationale for his or her opinion(s) in the examination report. If any of the above requested opinions cannot be made without resort to speculation, the examiner must state this and provide a rationale for such conclusion. 3. Schedule the Veteran for an examination for flatfoot/pes planus with an appropriate clinician for her claimed fallen arches. The entire claims file and a copy of this remand must be made available to the examiner for review. The examiner must provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s fallen arches (if existing at any time during the appeal period since February 2012) began during active service or is related to an incident of service including the in-service motor vehicle accident or physical training. The examiner must provide all findings, along with a complete rationale for his or her opinion(s) in the examination report. If any of the above requested opinions cannot be made without resort to speculation, the examiner must state this and provide a rationale for such conclusion. 4. Return the Veteran’s claims file to the examiner who conducted the December 2013 VA DBQ examination for neck conditions so an opinion may be provided. If that examiner is no longer available, provide the Veteran’s claims file to a similarly qualified clinician. The entire claims file and a copy of this remand must be made available to the examiner for review. A new examination is only required if deemed necessary by the examiner. The examiner must provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s cervical spine disorder, to include cervical strain (as noted in a June 2012 VA treatment record even if since resolved) began during active service or is related to an incident of service, to include a motor vehicle accident in 1982. The examiner must provide all findings, along with a complete rationale for his or her opinion(s) in the examination report. If any of the above requested opinions cannot be made without resort to speculation, the examiner must state this and provide a rationale for such conclusion. 5. Return the Veteran’s claims file to the examiner who conducted the December 2013 VA DBQ examination for skin diseases so a supplemental opinion may be provided. If that examiner is no longer available, provide the Veteran’s claims file to a similarly qualified clinician. The entire claims file and a copy of this remand must be made available to the examiner for review. A new examination is only required if deemed necessary by the examiner. The examiner must provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s skin disorder began during active service or is related to an incident of service, to include gynecological treatment for warts on the labia in November 1984. The examiner must provide all findings, along with a complete rationale for his or her opinion(s) in the examination report. If any of the above requested opinions cannot be made without resort to speculation, the examiner must state this and provide a rationale for such conclusion. 6. Return the Veteran’s claims file to the examiner who conducted the December 2013 VA DBQ examination for ankle conditions so a supplemental opinion may be provided. If that examiner is no longer available, provide the Veteran’s claims file to a similarly qualified clinician. The entire claims file and a copy of this remand must be made available to the examiner for review. A new examination is only required if deemed necessary by the examiner. The examiner must provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s left ankle disorder began during active service or is related to an incident of service, to include treatment for ankle pain in November 1980 and motor vehicle accident in April 1982. The examiner must provide all findings, along with a complete rationale for his or her opinion(s) in the examination report. If any of the above requested opinions cannot be made without resort to speculation, the examiner must state this and provide a rationale for such conclusion. 7. Return the Veteran’s claims file to the examiner who conducted the December 2013 VA DBQ examination for knee and lower leg conditions so a supplemental opinion may be provided. If that examiner is no longer available, provide the Veteran’s claims file to a similarly qualified clinician. The entire claims file and a copy of this remand must be made available to the examiner for review. A new examination is only required if deemed necessary by the examiner. The examiner must provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s right knee disorder (a) began during active service, (b) is related to an incident of service, to include treatment for knee pain in November 1980 and motor vehicle accident in April 1982, or (c) if symptoms of arthritis began within one year after discharge from active service. The examiner must provide all findings, along with a complete rationale for his or her opinion(s) in the examination report. If any of the above requested opinions cannot be made without resort to speculation, the examiner must state this and provide a rationale for such conclusion. 8. Return the Veteran’s claims file to the examiner who conducted the December 2013 VA DBQ examination for back conditions so a supplemental opinion may be provided. If that examiner is no longer available, provide the Veteran’s claims file to a similarly qualified clinician. The entire claims file and a copy of this remand must be made available to the examiner for review. A new examination is only required if deemed necessary by the examiner. The examiner must provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s low back disorder (a) began during active service, (b) is related to an incident of service, to include motor vehicle accident in April 1982 and treatment for low back pain in August 1982, or (c) if symptoms of arthritis began within one year after discharge from active service. The examiner must provide all findings, along with a complete rationale for his or her opinion(s) in the examination report. If any of the above requested opinions cannot be made without resort to speculation, the examiner must state this and provide a rationale for such conclusion. 9. Then, review the examination reports and medical opinions to ensure that the requested information was provided. If any report or opinion is deficient in any manner, the RO must implement corrective procedures. 10. Then, readjudicate the claims. If any decision is unfavorable to the Veteran, issue a Supplemental Statement of the Case and allow the applicable time for response. Then, return the case to the Board. D. Martz Ames Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T. Carter, Counsel