Citation Nr: 18154657 Decision Date: 11/30/18 Archive Date: 11/30/18 DOCKET NO. 16-58 857 DATE: November 30, 2018 REMANDED Entitlement to service connection for a back disorder, claimed as middle back injuries, is remanded. Entitlement to service connection for an upper back/neck disorder is remanded. REASONS FOR REMAND The Veteran had active duty service in the United States Marine Corps from November 2002 to November 2006. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a May 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in San Diego, California. 1. Entitlement to service connection for a back disorder, claimed as middle back injuries, is remanded. 2. Entitlement to service connection for an upper back/neck disorder is remanded. Although the Board sincerely regrets the additional delay, it is necessary to ensure that there is a complete record upon which to decide the Veteran’s claims so that he is afforded every possible consideration. As to the Veteran’s service connection claims, the Board notes that the Veteran has not been afforded a VA examination for these disabilities. According to McLendon, an examination is required when (1) there is evidence of a current disability, (2) evidence establishing an “in- service event, injury, or disease,” or that a disease, manifested in accordance with presumptive service connection regulations, occurred which would support incurrence or aggravation, (3) an indication that the current disability may be related to the in-service event, and (4) insufficient evidence to decide the case. McLendon v. Nicholson, 20 Vet. App. 79 (2006). In this case, the Veteran has reported present disabilities, has related these disabilities to his service in the Marine Corps and Iraq, and there is insufficient evidence to decide the case. As the Board finds that the criteria set forth in McLendon has been met as to these claims, VA examinations should be obtained. In addition, the Board notes that the Veteran has reported to VA that he has received chiropractic care for these disabilities and that his chiropractor sent these records to VA. After a review of the record, the Board notes that these private treatment records have not been associated with the Veteran’s claims file. Consequently, a remand is necessary because VA’s duty to assist requires that efforts be made to obtain these treatment records. See 38 U.S.C. § 5103A (2012); 38 C.F.R. § 3.159 (2017). The matters are REMANDED for the following action: 1. Contact the Veteran and ask the Veteran to identify all of his private treatment providers, to include the chiropractor he treated with in California, in order for VA to obtain these records. 2. Since only VA psychiatric treatment records are contained in the record, take the step necessary to obtain all of the Veteran’s VA treatment records from the Santa Ana, Long Beach, and San Diego, California VA treatment facilities. 3. Schedule the Veteran for an appropriate VA examination to determine the nature and etiology of the Veteran’s back disorder and upper back/neck disorder. The electronic claims file must be reviewed by the examiner. All indicated studies and testing must be conducted, and all pertinent symptomatology must be reported in detail. After a review of the claims file, the examiner should provide answers to the following questions: (A). Identify all back disorders that are currently present. (B). Is it at least as likely as not (50 percent probability or greater) that the Veteran’s back disorder, had its onset in service or is caused by or related at least in part to his active service? (C). Is it at least as likely as not that the Veteran’s back disorder manifested itself in the first post-service year? (A). Identify all neck disorders that are currently present. (B). Is it at least as likely as not (50 percent probability or greater) that the Veteran’s neck disorder, had its onset in service or is caused by or related at least in part to his active service? (C). Is it at least as likely as not that the Veteran’s back neck disorder manifested itself in the first post-service year? In providing all of the requested opinions, the examiner should consider the Veteran’s competent lay claims regarding the observable symptoms he has experienced. The VA examination report must include a complete rationale for all opinions expressed. In providing the requested opinions, the examiner cannot rely exclusively on the absence of relevant treatment in the Veteran’s medical history. If the examiner feels that any of the requested opinions cannot be rendered without resorting to speculation, the examiner must state whether the need to speculate is caused by a deficiency in the state of general medical knowledge (i.e. no one could respond given medical science and the known facts) or by a deficiency in the record or the examiner (i.e. additional facts are required, or the examiner does not have the needed knowledge or training). Michael J. Skaltsounis Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Rescan, Associate Counsel