Citation Nr: 18155543 Decision Date: 12/04/18 Archive Date: 12/04/18 DOCKET NO. 17-20 276 DATE: December 4, 2018 REMANDED Entitlement to service connection for radiculopathy, left lower extremity, to include as secondary to service-connected lumbar strain is remanded. Entitlement to service connection for radiculopathy, right lower extremity, to include as secondary to service-connected lumbar strain is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from March 1974 to October 1974. This matter is before the Board of Veterans’ Appeal (Board) on appeal from an April 2015 rating decision issued by the Department of Veteran Affairs (VA) Regional Office (RO) in Decatur, Georgia. In April 2017, the Veteran submitted an unsigned VA Form 21-22 (Appointment of Veterans Service Organization as Claimant’s Representative) transferring her Power of Attorney from The American Legion to Disabled American Veterans. This 21-22, though signed by the Veteran, was not signed by a representative from the DAV, nor was it acknowledged by the RO. Accordingly, the Veteran’s representative remains The American Legion. 1. Entitlement to service connection for radiculopathy, left lower extremity, to include as secondary to service-connected lumbar strain is remanded. 2. Entitlement to service connection for radiculopathy, right lower extremity, to include as secondary to service-connected lumbar strain is remanded. The Veteran seeks service connection for radiculopathy of the left and right lower extremities (bilateral lower extremities radiculopathy). The Veteran contends her claimed bilateral radiculopathy was caused or aggravated by her service-connected lumbar strain. The Veteran was afforded VA back conditions examinations in July 2013, November 2014, and January 2016 related to her service-connected lumbar strain. None of the examinations recognized that the Veteran was diagnosed with a neurological disability, to include radiculopathy. To the extent that these examinations acknowledged the Veteran’s claimed radiculopathy, they attributed these symptoms to her non-service connected diabetes. That said, the Veteran has not been provided with a VA examination to exclusively related to the etiology and nature of her claimed bilateral lower extremities radiculopathy. The Veteran submitted private medical opinions dated April 2017 and June 2017, both of which opined that the Veteran’s bilateral radiculopathy of the lower extremities is secondary to her service-connected lumbar strain. The Board does not find these nexus statements to be credible. Indeed, it appears to the Board that the purported nexus letters were drafted by someone other than the doctor and then later had the doctor’s signature appended to it. Of particular note, on the June 2017 letter, the doctor’s name in the signature block is different than it appears on the typed letterhead. The letter itself has grammar mistakes (such as unneeded apostrophes and odd capitalization) and syntax errors (such as stating that the Veteran “has taken various MRI’s at the Department of Veteran;”, a phrasing the Board has never seen a medical professional use) that cause the Board to question the June 2017 letter’s provenance. Both letters stated that the Veteran “has no other ailments as well as no other known risk factors that may precipitate her current conditions,” a statement contrary to previous VA examinations that have attributed her claimed symptoms to her diabetes. Finally, both letters stated that it is “more likely that [the Veteran’s] conditions are contributing to her lumbar strain,” but in this context, the Board is looking for evidence that the Veteran’s lumbar strain has resulted in or aggravated her other claimed conditions, namely radiculopathy. Therefore, the exact nature and etiology of the Veteran’s claimed neurological condition is unclear. Under these circumstances, the Board will not proceed with final adjudication of the claims until a competent medical opinion with supporting rationale is obtained that adequately addresses the etiology of the Veteran’s claimed disability. McLendon v. Nicholson, 20 Vet. App. 79 (2006). The matters are REMANDED for the following actions: 1. Provide the Veteran the opportunity to submit medical records of her private medical treatment for her service-connected back disability and claimed radiculopathy of the bilateral lower extremities. 2. Schedule the Veteran for an appropriate VA examination to determine the nature and etiology of any current neurological disability of the lower extremities, to include radiculopathy. The evidence of record, to include a copy of this Remand, must be made available to the examiner and the examiner must indicate that the pertinent medical records and lay statements have been reviewed. Following a review of the record, the examiner must address the following: (a) Provide diagnoses for all current bilateral lower extremity neurological condition, to include radiculopathy, to include those noted during the appeal period. (b) Is it at least as likely as not (a 50 percent probability or greater), that any bilateral neurological condition of the lower extremities began in service, was caused by service, or is otherwise related to the Veteran’s military service? (c) Is it at least as likely as not (50 percent or greater probability) that any bilateral neurological condition of the lower extremities was caused by the Veteran’s service-connected lumbar strain? (d) Is it at least as likely as not (50 percent or greater probability) that any bilateral neurological condition of the lower extremities was chronically worsened (aggravated) by the Veteran’s service-connected lumbar strain? (e) The examiner should address the Veteran’s June 2017 private medical opinion that held that the Veteran’s has a diagnosis of radiculopathy, which is secondary to her service-connected lumbar strain. (Continued on next page) A detailed rationale supporting the examiner’s opinion must be provided. If the examiner is unable to offer the requested opinion, it is essential that the examiner offer a rationale for the conclusion that an opinion could not be provided without resort to speculation, together with a statement as to whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. See Jones v. Shinseki, 23 Vet. App. 382 (2010). Evan M. Deichert Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. R. Higgins, Associate Counsel