Citation Nr: 19144591 Decision Date: 06/10/19 Archive Date: 06/10/19 DOCKET NO. 11-01 769 DATE: June 10, 2019 REMANDED Entitlement to service connection for a low back disability, to include as secondary to service-connected disability, is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1966 to May 1972, December 1990 to July 1991, October 1993 to February 1994, and from March 2003 to February 2004. Entitlement to service connection for a low back disability, to include as secondary to service-connected disability, is remanded. While further delay is regrettable, additional development is necessary before a decision may be rendered in the matter on appeal. In that regard, the Board remanded the claim in December 2017 so that a new Department of Veterans Affairs (VA) examination could be obtained to address the etiology of the Veteran’s low back disability. While a new examination was provided in January 2018, the Board finds an additional opinion must be obtained because the examiner did not provide sufficient rationale for the negative opinions stated. Accordingly, remand is required so that a new VA opinion may be obtained. Updated relevant VA treatment records should also be associated with the record. The matter is REMANDED for the following action: 1. Ask the Veteran to identify all outstanding treatment records relevant to her low back disability. All identified VA records should be added to the claims file. All other properly identified records should be obtained if the necessary authorization to obtain the records is provided by the Veteran. If any records are not available, or the Veteran identifies sources of treatment but does not provide authorization to obtain records, appropriate action should be taken (see 38 C.F.R. § 3.159(c)-(e)), to include notifying the Veteran of the unavailability of the records. 2. After the above development has been completed to the extent possible, send the claims file to an appropriate VA examiner for an addendum opinion with respect to the Veteran’s claim for entitlement to service connection for a low back disability, to include as secondary to her service-connected bilateral plantar fasciitis. The claims file must be reviewed by the examiner. If a new examination is deemed necessary to respond to the request, one should be scheduled. After review of the claims file, the examiner should opine on the following: (a) Whether it is at least as likely as not (50 percent probability or greater) that any current low back disorder is proximately due to or the result of the Veteran’s service-connected left knee osteoarthritis with meniscal tear and patellofemoral pain syndrome, right knee osteoarthritis with patellofemoral pain syndrome, partial ostectomy of the 5th toe of the left foot with partial matrixectomy of the 4th toe of the left foot, partial ostectomy of the 5th toe of the right foot, and/or bilateral plantar fasciitis, to include any alteration in station or gait associated with these disabilities. (b) Whether it is at least as likely as not (50 percent probability or greater) that there has been any increase in severity beyond the natural progression of the Veteran’s low back disorder as result of a her service-connected left knee osteoarthritis with meniscal tear and patellofemoral pain syndrome, right knee osteoarthritis with patellofemoral pain syndrome, partial ostectomy of the 5th toe of the left foot with partial matrixectomy of the 4th toe of the left foot, partial ostectomy of the 5th toe of the right foot, and/or bilateral plantar fasciitis, to include any alteration in station or gait associated with these disabilities. (c) If the examiner finds that a low back disorder has been aggravated, the examiner should attempt to quantify the degree of aggravation beyond the baseline level of severity that is due to any service-connected disability. (Continued on the next page)   A complete medical rationale must be provided for any opinion expressed. P.M. DILORENZO Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Bruce, 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.