Citation Nr: 18149738
Decision Date: 11/13/18	Archive Date: 11/13/18

DOCKET NO. 16-52 908
DATE:	November 13, 2018
REMANDED
Entitlement to service connection for a low back disability is remanded.
REASONS FOR REMAND
The appellant is a Veteran who served on active duty from March 1952 to December 1953.  This matter is before the Board of Veterans’ Appeals (Board) on appeal from a March 2015 rating decision.
Entitlement to service connection for a low back disability is remanded.
The Board notes that this claim has already been remanded for additional development.  While the Board regrets the delay inherent with yet another remand, the Board finds that there has not been substantial compliance with the previous remand directives, and that corrective action is necessary.  See Stegall v. West, 11 Vet. App. 268, 271 (1998).  
Specifically, the March 2018 Board remand directed that the Veteran’s claims file be forwarded for to an orthopedist for review and a medical advisory opinion as to the etiology of the Veteran’s current low back disability.  A review of the record found that the October 2018 medical advisory opinion was by an internist, and not an orthopedist as sought; more significantly, it is inadequate.  The record includes a report of a January 1992 chest X-Ray which showed minimal diffuse idiopathic skeletal hyperostosis (DISH) of the thoracic spine.  It also includes reports of 2015 thoracic and lumbar spine X-Rays which found mild degenerative changes of the lower thoracic spine, and Mild/moderate degenerative changes predominantly at L5-S1.  However, the October 2018 consulting provider stated that there was no current imaging such as X-Ray or MRI showing a structural or anatomic problem.  As the opinion offered is apparently based on a less than complete review of the record (and premised on inaccurate factual data) it is inadequate for rating purposes.  Accordingly, a new advisory medical opinion is necessary.  
The matter is REMANDED for the following:
The AOJ should arrange for the Veteran’s record to be forwarded to an orthopedist for review and an advisory medical opinion regarding the etiology of his current low back disability.  [If further examination of the Veteran is deemed necessary, such should be arranged.]  The consulting provider should note that the Veteran is presumed to have been sound on entry in service with respect to a low back disability, and the rationale for the opinion should acknowledge and account for the Veteran’s STRs showing treatment for back complaints and injuries in service.  Upon review of the record (to the discussion above) the provider should respond to the following:  
(a.) Please identify (by diagnosis) each low back disability entity shown by the record during the pendency of the instant claim.
(b.) Please identify the likely etiology for each low back disability entity diagnosed.  Specifically, is it at least as likely as not (a 50% or better probability) that the diagnosed entity is etiologically related to the Veteran’s service, to include as due to injuries for which the Veteran received treatment in service?  
(c.) If a diagnosed back disability entity is determined to not be related to the Veteran’s service, please identify the etiology for the disability considered more likely (and explain why that is so).
All opinions must include rationale.

 
GEORGE R. SENYK
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	N. Staskowski, Associate Counsel