Citation Nr: 18100970 Decision Date: 04/25/18 Archive Date: 04/25/18 DOCKET NO. 14-15 245A DATE: April 25, 2018 ISSUES DECIDED: 0 ISSUES REMANDED: 4 REMANDED ISSUES Entitlement to service connection for a cervical spine disability, to include degenerative disc disease and degenerative arthritis; for a respiratory disability, to include bronchiectasis; for a brain disability, secondary to a traumatic brain injury; and for a neurological disability, to include a phrenic nerve injury resulting in an elevated right hemidiaphragm, are remanded for additional development. The Veteran was afforded a VA examination in March 2012 with respect to the service connection claim for a cervical spine disability. March 2012 Neck Conditions VA Examination Report. In rendering a negative nexus opinion, the VA examiner failed to consider and weigh his relevant lay statements of record regarding an in service incurrence. See Buchanan v. Nicholson, 451 F.3d 1331, 1336 (2006). Thus, an addendum VA medical opinion is necessary. The Veteran’s service connection claim for neurological disability, to include a phrenic nerve injury resulting in an elevated right hemidiaphragm, is inextricably intertwined with the service connection claim for a cervical spine disability because the evidence of record suggests it may be due to nerve injury following trauma at the C3, C4, and C5. See January 2016 VA Pulmonary Consult Note; Harris v. Derwinski, 1 Vet. App. 180 (1991), overruled on other grounds by Tyrues v. Shinseki, 23 Vet. App. 166 (2009); Anglin v. West, 11 Vet. App. 361, 367 (1998). As a result, further development for this claim is dependent on the addendum medical opinion requested above. The Veteran underwent a VA examination in March 2013 with respect to the service connection claim for a respiratory disability. March 2013 Respiratory Conditions VA Examination Report. At that time, he had yet to be diagnosed with bronchiectasis, which occurred in May 2017. May 2017 VA Pulmonary Consult. See Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007), citing Ardison v. Brown, 6 Vet. App. 405, 407 (1994). Expectedly, the VA examiner’s opinion did not address this diagnosis. As such, a new VA examination is necessary. The Veteran was also examined by the VA in March 2013 with respect to the service connection claim for a brain disability, secondary to a traumatic brain injury. March 2013 Central Nervous System and Neuromuscular Disease VA Examination Report. At that time, the VA examiner confirmed he was diagnosed with mega cisterna magna versus arachnoid cyst in September 2011. In proffering a negative nexus opinion, although the VA examiner acknowledged that an arachnoid cyst could be the result of non-developmental causes such as adhesions, the VA examiner did not consider and weigh his relevant lay statements of record regarding an in service incurrence. See Buchanan, supra. For this reason, a new VA examination is necessary. The matters are REMANDED for the following action: 1. Obtain an addendum medical opinion from an appropriate medical professional regarding the nature and etiology of the Veteran’s claimed cervical spine disability. After reviewing the record, the examiner should: (a.) Opine as to whether it is at least as likely as not (50 percent probability or greater) the Veteran’s diagnoses of degenerative disc disease and degenerative joint disease of the cervical spine were caused by or are otherwise related to his active duty service, to include the injuries he sustained to his head and neck as a result of an explosion in June 2004, and explain why. (b.) In rendering an opinion, the examiner should consider whether the Veteran’s relevant lay statements of record present sufficient etiological evidence and explain why. The examiner is advised the Board finds the Veteran’s lay statements of record regarding the June 2004 explosion and the injuries he sustained to his head and neck credible. 2. If and only if the Veteran’s claimed cervical spine disability is caused by or otherwise related to his active duty service, schedule him for an examination with an appropriate medical professional to determine the nature and etiology of his claimed neurological disability. After reviewing the record, the examiner should conduct all tests and examinations deemed necessary to determine whether the Veteran has a phrenic nerve injury resulting in an elevated right hemidiaphragm. 3. Once each of the above requests has been completed, to the extent possible, schedule the Veteran for an examination with an appropriate medical professional to determine the nature and etiology of his claimed respiratory disability. After reviewing the record, the examiner should: (a.) Identify all current and prior diagnoses of a respiratory disability, to include bronchiectasis. (b.) Reconcile all prior diagnoses of a respiratory with the current findings. If any prior diagnosis cannot be reconciled with the current findings, explain why. (c.) As to each current diagnosis and any prior diagnosis that cannot be reconciled with the current findings, opine as to whether it is at least as likely as not (50 percent probability or greater) caused by or otherwise related to the Veteran’s active duty service, to include his environmental exposures during his service in the Southwest Asia theater, and explain why. (d.) In rendering an opinion, the examiner should consider and weigh the Veteran’s relevant lay statements of record. 4. Schedule the Veteran for an examination with an appropriate medical professional to determine the nature and etiology of his claimed brain disability, secondary to a traumatic brain injury. After reviewing the record, the examiner should: (a.) Conduct all tests and examinations deemed necessary to determine whether the Veteran has a brain disability, secondary to a traumatic brain injury. In doing so, clarify his September 2011diagnosis of mega cisterna magna versus arachnoid cyst. (b.) Reconcile all prior diagnoses of a brain disability with the current findings. If any prior diagnosis cannot be reconciled with the current findings, explain why. (c.) As to each current diagnosis and any prior diagnosis that cannot be reconciled with the current findings, opine as to whether it is at least as likely as not (50 percent probability or greater) caused by or otherwise related to the Veteran’s active duty service, to include the injuries he sustained to his head and neck as a result of an explosion in June 2004, and explain why. (d.) In rendering an opinion, the examiner should consider whether the Veteran’s relevant lay statements of record present sufficient etiological evidence and explain why. The examiner is advised the Board finds the Veteran’s lay statements of record regarding the June 2004 explosion and the injuries he sustained to his head and neck credible. 5. Once each of the above requests has been completed, to the extent possible, readjudicate the appeal. L. M. BARNARD Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD G. Suh, Associate Counsel