Citation Nr: 18136286
Decision Date: 09/19/18	Archive Date: 09/18/18

DOCKET NO. 16-12 734
DATE:	September 19, 2018
REMANDED
Service connection for a low back disorder.
REASONS FOR REMAND
The Veteran had active service from May 2001 to June 2008. 
Service treatment records (STRs) show that the Veteran complained of, and was later service connected for, a left knee disability. Subsequently, he was diagnosed with lumbar strain and associated degenerative changes.
Post-service treatment records indicated that the Veteran fell several times due to his service-connected left knee disability, including in May 2009 and January 2010, and that his back pain began since that time.  In August 2010, a VA treatment provider opined that the Veteran’s low back pain was secondary to his service-connected left knee disability, but provided no rationale. A December 2010 VA examination provided an opinion only on direct service connection. 
In June 2013, another VA examiner opined that the Veteran’s low back disorder was less likely than not proximately due to or the result of his service-connected knee disability, reasoning that there was no medical evidence of connection but based the opinion only on the Veteran’s gait and did not considered the post-service falls.  
Accordingly, another examination is needed to address whether the Veteran’s falls have caused his low back disorder.
The matter is REMANDED for the following actions:
1. Identify and obtain any pertinent, outstanding VA and private treatment records and associate them with the claims file. 
2. Schedule the Veteran for an examination to determine the current nature and etiology of his low back disorder. Any diagnosis found should be clearly reported. The claims file must be made available to, and reviewed by the examiner.  Any indicated studies should be performed.
Based on the examination results and review of the record, the examiner is asked to provide the following opinion: 
(a)	Is it at least as likely as not (50 percent or greater probability) that the Veteran’s low back disorder was caused or permanently worsened by a service-connected disability, to specifically include his left knee disability?
(b)	Is it at least as likely as not (50 percent or greater probability) that the Veteran’s low back disorder was caused or permanently worsened by the post-service falls as cited in his medical records? 
In so deciding, the examiner should specifically consider and address the Veteran’s post-service complaints of low back pain, as well as the August 2010 VA treatment provider’s opinion that the Veteran’s low back disorder is secondary to his service-connected left knee disability. 
A thorough rationale for any opinions rendered should be provided. 
3. Then, readjudicate the claim.  If a decision is adverse to the Veteran, issue a supplemental statement of the case and allow the appropriate time for response.  Then, return the case to the Board.  
 
L. HOWELL
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	M. Yacoub, Associate Counsel