Citation Nr: 18160151 Decision Date: 12/26/18 Archive Date: 12/26/18 DOCKET NO. 16-63 836 DATE: December 26, 2018 REMANDED The issue of entitlement to service connection for a back disability, to include as secondary to service-connected traumatic neuropathy (claimed as a right foot condition with numbness/lack of feeling in right foot), is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1980 to January 1984. In June 2016, the Veteran filed a claim for service connection for an acquired back condition secondary to his service-connected traumatic neuropathy associated with residuals of an in-service lower right leg laceration injury. At a July 2016 VA examination, the Veteran was diagnosed with lumbosacral strain, degenerative arthritis of the spine and intervertebral disc syndrome. The examiner opined that the Veteran’s occupation as a plumber, history of right hip trauma and long-term tobacco use were more likely than not the cause of his current back condition and it was less likely than not that his back condition was caused by his right peroneal neuropathy. In his October 2016 notice of disagreement, the Veteran argued that his back condition “was made worse over the years because of being unbalanced” due to his service-connected right leg traumatic neuropathy. He indicated that most of his back problems affected the right side of his body. He believed this was due to being misaligned while working because of right leg neuropathy. He reported experiencing severe and extreme shooting pain all on the right side and none on his left. In his December 2016 Form 9, the Veteran clarified that he was claiming his back condition was worsened or aggravated by the service-connected disability. He indicated that he felt the cause of his back condition was the years of working as a commercial plumber with constant standing on and climbing ladders, along with heavy lifting. However, he again argued that his right leg traumatic neuropathy caused his body to be out of balance and alignment while performing his job duties and that misalignment caused the nerves to be pinched on his right side. He reported doctors told him his radiating pain was caused by pinched nerves in his back and not by a non-service related hip injury. As only his right side was affected, he believes his right leg traumatic neuropathy “was the cause of the increase in severity of pain.” Following a February 2017 supplemental statement of the case (SSOC) and certification to the Board, the VA afforded the Veteran another VA examination in February 2018. An examiner was asked whether the Veteran’s back condition was at least as likely as not proximately due to or the result of traumatic neuropathy. The examiner opined that the Veteran had damage to his nerve from a laceration in 1981 and that injury to the nerve caused numbness of the right lateral lower leg and dorsum of the foot. He concluded the that Veteran’s back condition, which had onset in 2012, was more likely caused by his many years as a plumber which included heavy lifting. He explained that a direct nerve injury in the lower leg would in no way travel up to the back to cause degenerative disc disease or degenerative joint disease, which is degeneration of the bone. Although the Agency of Original Jurisdiction (AOJ) did not provide an additional SSOC following that pertinent examination, the Board of Veterans’ Appeals (Board) finds that remand is necessary for further development to fully satisfy the duty to assist and that any procedural error is harmless as another SSOC will be issued once the additional development is completed. Under section 3.310(a), establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). Here, the record does not yet include an opinion addressing whether it is at least as likely as not that traumatic neuropathy aggravated the Veteran’s back condition beyond its normal progression. The opinions of record only address causation. Once an aggravation opinion is rendered, if service connection remains denied, the AOJ should issue another SSOC that considers all pertinent evidence, to include the February 2018 VA examination and opinion. The matter is REMANDED for the following action: 1. Associate all outstanding VA treatment records with the electronic claims file. 2. Refer the Veteran’s VA claims file to the VA examiner who conducted the February 2018 VA examination, or if unavailable, another suitably qualified VA medical professional, for a supplemental opinion regarding the etiology of the Veteran’s back condition. If, after review of the claims file, the examiner determines that another VA examination is necessary, such must be scheduled and the Veteran must be notified. Thereafter, the examiner is asked to address whether it is at least as likely as not (i.e., probability of 50 percent or greater) that a currently diagnosed back disability was aggravated beyond its natural progression by service-connected traumatic neuropathy (claimed as a right foot condition with numbness/lack of feeling in right foot). The Board is seeking an opinion regarding aggravation only and an opinion regarding causation that does not address aggravation will be found inadequate. The examiner should carefully consider the Veteran’s arguments in support of his claim for service connection based on aggravation and provide a rationale for all opinions provided. If the examiner is unable to provide an opinion without resort to speculation he or she should explain why. Nathan Kroes Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C. Boyd Iwanowski, Counsel