Citation Nr: 18159852 Decision Date: 12/20/18 Archive Date: 12/20/18 DOCKET NO. 14-14 542 DATE: December 20, 2018 REMANDED Entitlement to service connection for lumbar spine disability is remanded. REASONS FOR REMAND The Veteran served on active duty from December 1977 to December 1979 in the United States Army. The matter comes before the Board of Veterans’ Appeals (Board) on appeal from a May 2010 rating decision by the Department of Veterans Affairs (VA). Entitlement to service connection for lumbar spine disability is remanded. The Veteran contends that her degenerative thoracolumbar spine disability is related to back trauma that she experienced during service. In a November 2018 correspondence, the Veteran’s representative argued the Board’s prior remand directive had not been substantially met. The Board agrees. In December 2015, the Board remanded the issue of service connection for a back disability. The Board noted competent lay statements made by the Veteran in regard to the onset and nature of her back pain. Further, her medical treatment records were positive for a diagnosis of chronic back pain. The Board remanded the appeal for a VA examination to determine the nature and etiology of her back disability. The remand directives were as follows: “[t]he examiner should state an opinion as to whether it is at least as likely as not (50 percent probability or more) that the Veteran’s current back disability began in service, was caused by service, or is otherwise related to service. The examiner must provide a complete rationale for any opinion offered. In this regard, the examiner must consider and discuss the Veterans competent lay statements, as well as statements from her treating physicians that tend to establish a relationship between her current diagnosis and her in-service injuries. Specifically, the examiner should discuss the Veterans reports of ongoing back pain since service, as well as the clinician’s findings that her current disability is not of recent origin and stems from an old trauma.” Following the December 2015 remand, the Veteran was afforded a VA examination of her thoracolumbar spine in July 2018. Based upon review of the evidence and direct physical examination, the examiner Dr. B.R. opined that it is less likely than not that the Veteran’s degenerative arthritis of the spine was incurred in or caused by an in-service injury, event, or illness. His rationale reflects that “[d]uring service, condition was acute only. There is no evidence of chronicity of case. A nexus has not been established.” The Board finds that the medical opinion is inadequate because the physician does not provide adequate reasoning to support the conclusion, to include any discussion of the clinical evidence, medical history of noted treatment for back pain post-separation, or the Veteran’s lay statements regarding back pain. Therefore, the Board’s remand directives are not substantially met. See Dyment v. West, 13 Vet. App. 141, 146-47 (1999). A remand by the Board imposes upon the Secretary of VA a concomitant duty to ensure compliance with the terms of the remand. Where remand orders of the Board are not complied with, the Board errs in failing to insure compliance. Stegall v. West, 11 Vet. App. 268 (1998). Hence, remand is necessary. The matter is REMANDED for the following action: 1. Obtain an addendum opinion from Dr. B.R. or an appropriate clinician regarding whether the Veteran’s lumbar spine disability. As noted from the December 2015 remand directives, “the examiner should state an opinion as to whether it is at least as likely as not (50 percent probability or more) that the Veteran’s current back disability began in service, was caused by service, or is otherwise related to service. The examiner must provide a complete rationale for any opinion offered. In this regard, the examiner must consider and discuss the Veterans competent lay statements, as well as statements from her treating physicians that tend to establish a relationship between her current diagnosis and her in-service injuries. Specifically, the examiner should discuss the Veterans reports of ongoing back pain since service, as well as the clinician’s findings that her current disability is not of recent origin and stems from an old trauma.” 2. Ensure that the VA medical opinion obtained includes a complete rationale for the conclusions reached. The medical opinion must support the conclusions reached with an analysis that is adequate for the Board to consider and weigh against other evidence of record; medical opinions must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. If an opinion cannot be expressed without resort to speculation, ensure that the clinician so indicates and discusses why an opinion is not possible, to include 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. C.A. SKOW Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. A. Macek, Associate Counsel