Citation Nr: 18155711
Decision Date: 12/06/18	Archive Date: 12/04/18

DOCKET NO. 16-58 718A
DATE:	December 6, 2018
REMANDED
Entitlement to service connection for lumbar strain (claimed as low back pain), to include as secondary to service-connected right knee patellofemoral pain syndrome and joint osteoarthritis and left knee patellofemoral pain syndrome with degenerative arthritis, is remanded.
REASONS FOR REMAND
The Veteran served on active duty from February 1972 to February 1992.
The Veteran was afforded a VA examination to determine the nature and etiology of his lumbar strain in June 2015. The examiner stated that during service, the Veteran was involved in heavy labor with heaving lifting which is known to cause degeneration of the discs in the spine and recurrent thoracolumbar strains. However, he ultimately concluded that the Veteran’s lumber strain was less likely than not related to service because the earliest complaint of back pain was in April 2011, almost 20 years after separation from service. The Board finds this rationale insufficient because it fails to explain why the passage of time between the Veteran’s diagnosis of lumbar strain and his military service means there is no etiological connection between his back disability and service. In addition, the Veteran has submitted medical literature suggesting that his lumbar strain may be secondary to his service-connected right and left knee disabilities. See March 2018 Correspondence. For the aforementioned reasons, a new VA examination is necessary on remand. 
The matter is REMANDED for the following action:
1. Contact the Veteran and request authorization to obtain any outstanding records pertinent to his claims, to include any private treatment records, following proper VA procedures under 38 C.F.R. § 3.159(c).
2. After completing the requested development, afford the Veteran a VA spine examination from the appropriate clinician to determine the nature and etiology of his lumbar strain. The Veteran’s claims file must be made available to the examiner in conjunction with the examination. All tests deemed necessary should be performed, and all findings should be reported in detail. If possible, the appropriate Disability Benefits Questionnaire (DBQ) should be used. After reviewing the claims file, the examiner should answer all of the following questions completely:
(a.) Is it at least as likely as not (a fifty percent probability or greater) that the Veteran’s lumbar strain was caused by his service-connected right and/or left knee disability?
(b.) If the Veteran’s service-connected right and/or left knee disability did not cause lumbar strain, is it at least as likely as not that his lumbar strain was aggravated (permanently worsened beyond its natural progression) by his knee disabilities?
If aggravation is found, please identify to the extent possible the baseline level of disability prior to the aggravation and determine what degree of additional impairment is attributable to aggravation of lumbar strain by the service-connected disability.
(c.) If the answers to the preceding questions are negative, is it at least as likely as not that the lumbar strain began in service, or is otherwise related to a disease, event, or injury in service?
The examiner must provide a complete rationale for any opinion provided. The absence of evidence of treatment for lumbar strain in the Veteran’s service treatment records cannot, standing alone, be a sufficient rationale for providing a negative opinion. The examiner is also advised that the Veteran is competent to report his symptoms and history, and such reports must be specifically considered in formulating any opinions. If the examiner rejects the Veteran’s reports, the examiner should provide a reason for doing so.
 
A. C. MACKENZIE
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	C. Mukherjee, Associate Counsel