Citation Nr: 19191069 Decision Date: 12/04/19 Archive Date: 12/04/19 DOCKET NO. 16-50 255 DATE: December 4, 2019 REMANDED Entitlement to service connection for cervical osteoarthritis with stenosis, to include as secondary to post-operative degenerative disc disease (DDD), lumbar spine is remanded. Entitlement to service connection for radiculopathy, left upper extremity, secondary to cervical osteoarthritis with stenosis, and secondary to post-operative DDD, lumbar spine is remanded. Entitlement to service connection for radiculopathy, right upper extremity, secondary to cervical osteoarthritis with stenosis, and secondary to service-connected post-operative DDD, lumbar spine is remanded. Entitlement to service connection for headaches, secondary to service-connected post-operative degenerative disc disease (DDD), lumbar spine, and secondary to cervical osteoarthritis with stenosis is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1978 to September 1983. In his October 2016 VA Form 9, the Veteran requested a Board hearing by live Video Conference at a local VA office. (Video Conference hearing). It was noted in the December 2016 VA Form 8, Certification of Appeal, that a video hearing was pending. However, the Veteran was never scheduled for his requested Board hearing. The Veteran’s representative, in the July 2019 Appellant’s Brief, did not indicate whether the Veteran still desired a Board hearing. Consequently, in October 2019, the Veteran was sent a letter, requesting that he inform the RO as to whether he still desired a Video Conference hearing or any other type of Board hearing. The Veteran has not responded. As such, the hearing request is deemed withdrawn. 1. Entitlement to service connection for cervical osteoarthritis with stenosis, to include as secondary to service-connected post-operative (DDD), lumbar spine is remanded. 2. Entitlement to service connection for radiculopathy, left upper extremity, secondary to cervical osteoarthritis with stenosis, and secondary to service-connected post-operative (DDD), lumbar spine is remanded. 3. Entitlement to service connection for radiculopathy, right upper extremity, secondary to cervical osteoarthritis with stenosis, and secondary to service-connected post-operative (DDD), lumbar spine is remanded. Initially, the Board notes that the Veteran’s currently diagnosed bilateral upper extremity radiculopathy has already been found to be related to his currently diagnosed cervical osteoarthritis with stenosis. See March 2014 VA examination report. The Veteran also contends that his currently diagnosed cervical spine disability with bilateral upper extremity radiculopathy is related to his active military service and his service-connected low back disability. In this regard, he has reported neck pain in service and thereafter, related to and separate from his low back disability. See September 2013 statement in support of claim, September 2013 statement from the Veteran’s representative, January 2015 statement in support of claim, and January 2015 notice of disagreement (NOD). The Veteran was afforded a VA examination in March 2014. The examiner opined that the diagnosed cervical spine osteoarthritis with spinal stenosis and bilateral upper extremity cervical radiculopathy were less likely than not proximately due to or the result of the service-connected lumbar degenerative disc disease. The rationale was that there is no documentation in the Veteran’s medical records of any event that would link his low back condition to his cervical spine condition with radiculopathy. The examiner also stated that “it is not a commonly held medical belief” that a low back condition of lumbar DDD will cause a cervical spine condition or cervical radiculopathy. The Board finds the March 2014 examiner’s opinion inadequate for evaluation purposes. In this regard, when only considering the lack of medical evidence of a link between the Veteran’s cervical spine condition and his low back disability; the examiner did not consider the Veteran’s reports of cervical spine pain in service and thereafter, related to and separate from his service-connected low back disability. A medical opinion based solely on the absence of documentation in the record is inadequate if it does not take into account the Veteran's reports of symptoms and history. Dalton v. Nicholson, 21 Vet. App. 23 (2007). Furthermore, the examiner’s finding regarding what is a commonly held belief in the medical community does not consider this Veteran’s specific medical condition and medical history. Moreover, the examiner did not show that this finding was based on any irrefutable, empirical data or facts. To be adequate, a medical opinion must do more than merely state a conclusion regarding the etiology of the claimed disorder, instead, must also support the conclusion with sufficient rationale and explanation. Stefl v. Nicholson, 21 Vet. App. at 124 (2007). The probative value of an opinion is dependent, in part, upon the extent to which it reflects "clinical data or other rationale to support [the] opinion." Bloom v. West, 12 Vet. App. 185, 187 (1999). In addition, the Board notes that the examiner did not discuss whether the cervical spine disability or bilateral upper extremity radiculopathy were aggravated by the service-connected low back disability. As such, the opinion is incomplete and therefore, inadequate for evaluation purposes. Finally, as the Veteran also claims that he experienced neck pain during active duty, service connection on a direct basis must also be considered. The Board is required to consider all issues, and theories of entitlement, raised by the appellant. See Robinson v. Peake, 21 Vet. App. 545 (2008), citing Schroeder v. West, 212 F.3d 1265 (Fed. Cir. 2000). For these reasons, the Board believes that the Veteran should be afforded another VA examination and opinion to determine the etiology of any currently demonstrated cervical spine disability and radiculopathy of the upper extremities. Barr v. Nicholson, 21 Vet. App. 303 (2007). The Board also notes that the Veteran’s claims for service connection for left and right upper extremity radiculopathy are inextricably intertwined with his claim for service connection for cervical osteoarthritis with stenosis, which is being remanded for further adjudication. Therefore, a final decision on the issues of entitlement to service connection for left and right upper extremity radiculopathy cannot be rendered at this time. See Harris v. Derwinski, 1 Vet. App. 180 (1991) (two issues are "inextricably intertwined" when they are so closely tied together that a final decision on one issue cannot be rendered until a decision on the other issue has been rendered). 4. Entitlement to service connection for headaches, as secondary to service-connected post-operative DDD, lumbar spine, and as secondary to cervical osteoarthritis with stenosis is remanded. The Veteran contends that his currently diagnosed headache disorder is related to his service-connected low back disability and his currently diagnosed cervical spine disability. See September 2013 statement in support of claim, September 2013 statement from the Veteran’s representative, January 2015 statement in support of claim, January 2015 NOD, and July 2019 Appellant’s Brief. The March 2014 VA examiner opined that the Veteran’s headaches are secondary to his cervical spine osteoarthritis with stenosis. However, the examiner did not give an opinion as to whether the headaches are related to the service-connected low back disability. As such, the opinion is incomplete and therefore, inadequate for evaluation purposes. The Board is required to consider all issues, and theories of entitlement, raised by the appellant. See Robinson v. Peake, 21 Vet. App. 545 (2008), citing Schroeder v. West, 212 F.3d 1265 (Fed. Cir. 2000). For these reasons, the Board believes that the Veteran should be afforded another VA examination and opinion to determine the etiology of any currently demonstrated headache disorder. Barr v. Nicholson, 21 Vet. App. 303 (2007). The Board also notes that the claim for service connection for headaches is inextricably intertwined with the claim for service connection for cervical osteoarthritis with stenosis, which is being remanded for further adjudication. Therefore, a final decision on the issues of entitlement to service connection for headaches cannot be rendered at this time. See Harris v. Derwinski, 1 Vet. App. 180 (1991) (two issues are "inextricably intertwined" when they are so closely tied together that a final decision on one issue cannot be rendered until a decision on the other issue has been rendered). The matters are REMANDED for the following action: 1. Updated treatment records should be obtained and added to the claims file/e-folder. 2. Following completion of the above, schedule the Veteran for a VA examination to determine the nature and etiology of any currently diagnosed cervical spine disability, including cervical osteoarthritis with stenosis. The claims folder, including a copy of this remand, should be made available to the examiner for review in connection with the examination and the examiner should acknowledge such review in the examination report or in an addendum. The examiner should indicate the nature and severity of all manifestations of the cervical spine disability. Any testing deemed necessary should be performed, including X-rays. The examiner should provide an opinion as to whether it is at least as likely as not (50 percent probability or more) that any currently diagnosed cervical spine disability, including cervical osteoarthritis with stenosis, is etiologically related, in whole or in part, to the Veteran's active service. The examiner should also provide an opinion as to whether it is at least as likely as not (50 percent probability or more) that any currently diagnosed cervical spine disability, including cervical osteoarthritis with stenosis, was caused or aggravated (permanently increased in severity beyond the natural progression) by his service-connected low back disability. The examiner is advised that the Veteran is competent to report injuries and symptoms and that his reports must be considered in formulating the requested opinions. A complete rationale should be given for all opinions and conclusions expressed. If the examiner is unable to offer any of the requested opinions, it is essential that the examiner offer a rationale for the conclusion that an opinion could not be provided without resort to speculation, together with a statement as to 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. 3. Then schedule the Veteran for a VA examination to determine the nature and etiology of any currently diagnosed bilateral upper extremity cervical radiculopathy. The claims folder, including a copy of this remand, should be made available to the examiner for review in connection with the examination and the examiner should acknowledge such review in the examination report or in an addendum. The examiner should indicate the nature and severity of all manifestations of the bilateral upper extremity cervical radiculopathy. Any testing deemed necessary should be performed. The examiner should provide an opinion as to whether it is at least as likely as not (50 percent probability or more) that any currently diagnosed bilateral upper extremity cervical radiculopathy is etiologically related, in whole or in part, to the Veteran's active service. The examiner should also provide an opinion as to whether it is at least as likely as not (50 percent probability or more) that any currently diagnosed bilateral upper extremity cervical radiculopathy was caused or aggravated (permanently increased in severity beyond the natural progression) by his service-connected low back disability. The examiner is advised that the Veteran is competent to report injuries and symptoms and that his reports must be considered in formulating the requested opinions. A complete rationale should be given for all opinions and conclusions expressed. If the examiner is unable to offer any of the requested opinions, it is essential that the examiner offer a rationale for the conclusion that an opinion could not be provided without resort to speculation, together with a statement as to 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. 4. Then schedule the Veteran for a VA examination to determine the nature and etiology of any currently diagnosed headaches. The claims folder, including a copy of this remand, should be made available to the examiner for review in connection with the examination and the examiner should acknowledge such review in the examination report or in an addendum. The examiner should indicate the nature and severity of all manifestations of any currently diagnosed headaches. Any testing deemed necessary should be performed. The examiner should provide an opinion as to whether it is at least as likely as not (50 percent probability or more) that any currently diagnosed headaches are etiologically related, in whole or in part, to the Veteran's active service. The examiner should also provide an opinion as to whether it is at least as likely as not (50 percent probability or more) that any currently diagnosed headaches were caused or aggravated (permanently increased in severity beyond the natural progression) by his service-connected low back disability. The examiner is advised that the Veteran is competent to report injuries and symptoms and that his reports must be considered in formulating the requested opinions. A complete rationale should be given for all opinions and conclusions expressed. If the examiner is unable to offer any of the requested opinions, it is essential that the examiner offer a rationale for the conclusion that an opinion could not be provided without resort to speculation, together with a statement as to 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. 5. After completion of the above and any other development deemed necessary, readjudicate the Veteran's service connection claims, based on the entirety of the evidence. If any benefit sought on appeal is not granted, the AOJ should issue a supplemental statement of the case and provide the appropriate opportunity to respond, before returning the case to the Board, if otherwise in order. KELLI A. KORDICH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board F. Yankey, Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.