Citation Nr: 18106988
Decision Date: 06/01/18	Archive Date: 05/31/18

DOCKET NO. 11-23 739
DATE:	June 1, 2018
REMANDED
Entitlement to service connection for a low back disorder, to include as secondary to service-connected bilateral inguinal floor repairs with a recurrent right-sided hernia and bilateral hernia scars.  
REASONS FOR REMAND
In November 2014 and January 2017, the Board denied the appeal.  On both occasions, the Board’s decision was vacated by the United States Court of Appeals for Veterans Claims (Court).
Most recently, in January 2018, the Court vacated the Board’s January 2017 decision because of the Board’s reliance on an inadequate VA examination.  As explained by the Court, in a July 2018 opinion, the examiner relied on a lack of continuous treatment to support a negative opinion, without explanation as to why that fact was medically relevant.  In a March 2013 addendum, it appeared that the examiner again relied on a lack of continuous treatment as the basis for the opinion.
The matter is REMANDED for the following action:
1. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of his low back disorder.  
(A.)	The examiner must opine on whether the current low back disorder is at least as likely as not related to an in-service injury, event, or disease, including the cumulative effects of the rigors of military service.  These rigors include events such as removing a 250-pound salt water heater end cap and fighting a fire in 1973 for over 12 hours.  
In rendering this opinion, the examiner must consider that the Veteran has experienced continuous low back symptoms since service.  The examiner may not solely rely on a lack of continuity of care since service without explanation as to why that fact is medically relevant.  
The examiner must also consider the Veteran’s report of recurrent back pain on the May 1977 Report of Medical History at separation from service.
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(B.)	The examiner must additionally opine on whether the current low back disorder is at least as likely as not (1) proximately due to the service-connected bilateral inguinal floor repairs with a recurrent right-sided hernia and bilateral hernia scars, or (2) aggravated beyond its natural progression by the hernia disabilities. 

 
M. TENNER
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	J. Smith, Counsel