Citation Nr: 19174131 Decision Date: 09/24/19 Archive Date: 09/24/19 DOCKET NO. 14-21 267 DATE: September 24, 2019 REMANDED Entitlement to service connection for low back disability is remanded. Entitlement to service connection for arthritis of the entire body is remanded. REASONS FOR REMAND The Veteran had active service from April 1967 to February 1969. He served in Vietnam and was awarded the Combat Infantryman Badge (CIB). He testified at a Board videoconference hearing in January 2017 and the hearing transcript is associated with the record. The Board remanded the case in February 2018 for additional development. Following the remand, the Veteran at first appointed his son as his representative, and then shortly thereafter appointed the current representative. The current representative has been appointed as a “one-time representative” under the auspices of 38 C.F.R. § 14.630. Although the examinations requested by the remand were provided, the Board finds that the accompanying opinions are inadequate. So, these issues are being remanded again. The Veteran claims his current low back disability is related to an injury he sustained in a motor vehicle accident during service. He also claims arthritis of the entire body performing his duties as an infantryman, and maintains that arthritis symptoms have continued since active service. VA examinations were conducted in March 2019 and the examiner noted findings of lumbosacral strain, degenerative arthritis of the spine, and intervertebral disc syndrome (IDS) as well as generalized osteoarthritis in the neck, right shoulder, right wrist, bilateral hands, bilateral hips, and bilateral knees and gout arthritis in both feet. She then concluded that the Veteran’s back disorders were not related to his military service based on insufficient evidence of complaints or treatment during service. In support of this opinion she provided an incomplete and somewhat confusing rationale that the Veteran was diagnosed with lumbar strain related to a car accident during service, but that this information is not documented in military records, but rather acknowledged in 1993 by a private hospital. The examiner then noted that back osteoarthritis is a degenerative arthritis confirmed by imaging, and is not related to gout, which is a nondegenerative type of arthritis. In addition, the examiner failed to provide an opinion as to the etiology of the Veteran’s osteoarthritis involving the neck, right shoulder, right wrist, bilateral hands, bilateral hips, and bilateral knees. She also did not consider his assertions that his military duties caused his osteoarthritis, or his statements of continuous symptomatology since service. In this case the opinion does not assist the Board in making a determination and an additional medical opinion is needed. See Hayes v. Brown, 9 Vet. App. 67, 73 (1996); Barr v. Nicholson, 21 Vet. App. 303, 311 (2007) (When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate). The Board notes that the record documents several post-service injuries including a back injury in 1984. The Veteran also sustained an upper back/neck injury in October 2001, when a board fell on his head and that injury was exacerbated in a later slip and fall accident. So as part of the opinion, the examiner should acknowledge and fully discuss the evidence as documented in the claims file. The matters are REMANDED for the following action: 1. With any necessary identification of sources by the Veteran, obtain any outstanding VA and non-VA treatment records. All requests and responses for the records must be documented. 2. Forward the file to the VA examiner that provided the opinion in March 2019, if available. Otherwise, provide the record to another VA examiner who will have an opportunity to review the complete file. The need for an additional examination is left to the discretion of the medical professional offering the addendum opinion. Based on what is medically known about arthritis, the examiner should provide an opinion addressing whether it is at least as likely as not, i.e., a 50 percent probability or greater, that the Veteran’s currently diagnosed lumbar spine disorders and arthritis involving the neck, right shoulder, right wrist, bilateral hands, bilateral hips, and bilateral knees and gout arthritis in both feet--and any other lumbar spine disorder or arthritis involving any other joint present on examination--are related the in-service motor vehicle accident described by the Veteran and/or his military duties as an infantryman. If it is the examiner’s opinion that the Veteran’s lumbar arthritis/disc disease and multiple joint arthritis are the result of other processes unrelated to service, he/she should then address the likelihood that such disorders are due to post-service intercurrent causes, such as the Veteran’s post-service injuries, his post-service employment in construction, or age-related issues. In answering these questions, the examiner should carefully the objective medical findings in the service treatment records. He/She should discuss: 1) the Veteran’s reported in-service motor vehicle accident; 2) the theory that his military duties as an infantryman caused or contributed to his multiple joint arthritis; 3) the post-service injuries in 1984 and 2001; and 3) the Veteran’s assertions that his symptoms began during service and have existed since that time. The examiner should set forth medical reasons for accepting or rejecting the Veteran’s report (lay observations) of symptoms during and since service. The examiner must explain the underlying rationale for all opinions expressed, citing to supporting factual data/medical literature, as deemed indicated. If the examiner cannot render an opinion without resorting to mere speculation, a full and complete explanation for why an opinion cannot be rendered should be provided. Thomas H. O'Shay Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J.R. Bryant 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.