Citation Nr: 20002964 Decision Date: 01/14/20 Archive Date: 01/14/20 DOCKET NO. 17-15 904 DATE: January 14, 2020 REMANDED Entitlement to service connection for lumbar spine disability, to include lumbar strain, claimed as bruised coccyx bone and bulging disc is remanded. REASONS FOR REMAND The Veteran had active service in the United States Marine Corps from August 1977 to August 1980. The Veteran was afforded a video hearing before the Board in January 2020. This appeal was processed according to the Board’s One Touch Program. 1. Entitlement to service connection for lumbar spine disability, to include lumbar strain, claimed as bruised coccyx bone and bulging disc is remanded. Evidence indicates that there may be outstanding relevant VA treatment records. In a December 2019 VA treatment record, it was indicated that another MRI of the lumbar spine was being ordered becaue neurosurgery considered the 2016 MRI to be too old. Any VA treatment records are within VA’s constructive possession, and are considered potentially relevant to the issue on appeal. A remand is required to allow VA to obtain them. Additionally, the Board cannot make a fully-informed decision on the issue of entitlement to service connection for lumbar strain because no VA examiner has opined whether his disability is aggravated by his service connected nummular eczema (affecting the arms, lower trunk, and lower extremities). Specifically, at his January 2020 Board hearing the Veteran described having to stop receiving shots for his back due to his eczema, thereby worsening his back condition. The Board requests an examiner to elicit more information from the Veteran regarding how the cessation of shots due to eczema has affected his back, and provide a nexus opinion that addresses aggravation, as well as direct service connection. The matters are REMANDED for the following action: 1. Obtain the Veteran’s VA treatment records for the period from December 2019 to the present, to include an MRI of the lumbar spine which was ordered in December 2019. 2. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any lumbar spine disability. (a) The examiner must opine whether it is “at least as likely as not” (50 percent probability or greater) related to an in-service injury, event, or disease, to include residuals from his fall from a bunk bed landing on top of a gun rack with guns positioned upright in 1979. (b) Presumptive 3.309(a) - whether it at least as likely as not any arthritis of the lumbar spine (1) began during active service, (2) manifested within one year after discharge from service, or (3) was noted during service with continuity of the same symptomatology since service. (c) Secondary service connection – whether it is at least as likely as not the Veteran’s back disability underwent any incremental increase in disability, regardless of its permanence, due to: (i) the service-connected eczema disability, (ii) any other service-connected disability, (iii) medicine taken for his service-connected disabilities, to include medicine for his eczema that caused him to stop receiving shots for his spine? The term “incremental increase in disability” means additional impairment of earning capacity. Objective measurement, or numerical quantification, is not required to ascertain an increase in disability. Moreover, any “incremental increase in disability” need not be permanent. The term “at least as likely as not” does not mean “within the realm of medical possibility.” Rather, it means that the weight of medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of the conclusion (e.g., etiology) as it is to find against the conclusion. 3. THE AOJ MUST REVIEW THE CLAIMS FILE AND ENSURE THAT THE FOREGOING DEVELOPMENT ACTION HAS BEEN COMPLETED IN FULL. IF ANY DEVELOPMENT IS INCOMPLETE, APPROPRIATE CORRECTIVE ACTION MUST BE IMPLEMENTED. IF ANY REPORT DOES NOT INCLUDE ADEQUATE RESPONSES TO THE SPECIFIC OPINIONS REQUESTED, IT MUST BE RETURNED TO THE PROVIDING EXAMINER FOR CORRECTIVE ACTION. YVETTE R. WHITE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Barner, 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.