Citation Nr: 20002989 Decision Date: 01/14/20 Archive Date: 01/14/20 DOCKET NO. 18-03 679 DATE: January 14, 2020 REMANDED Entitlement to service connection for lower back disorder is remanded. REASONS FOR REMAND The Veteran served in the United States Marine Corps on active duty from January 1972 to December 1974. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a January 2016 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Montgomery, Alabama. Service connection for lower back disorder is remanded. The Veteran was afforded an examination for his lower back disorder in November 2017. The Board finds the VA examiner’s rationale for a negative nexus opinion for secondary service connection between the Veteran’s lower back disorder and his service-connected right knee and bilateral ankles insufficient, because the examiner failed to fully explain why these disabling conditions are unrelated. The Board notes that the examiner’s statement that “The medical literature does not support a medical relationship” is inadequate, as the examiner failed to cite to a particular medical treatise or factual data in support of her finding and/or explain why the Veteran’s specific lower back disorder could not have been aggravated by the Veteran’s service-connected right knee and bilateral ankle disabilities. Consequently, the Board finds the November 2017 VA examination for the Veteran’s lower back condition is inadequate, and that a new examination is warranted. When VA undertakes to provide a VA examination, it must ensure that the examination is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The matter is REMANDED for the following action: 1. Obtain any outstanding VA and private treatment records and associate them with the Veteran’s claims file. 2. Schedule the Veteran for a VA examination with an appropriate examiner (other than the November 2017 VA examiner) to evaluate the nature and etiology of his lower back disorder. Any and all studies, tests, and evaluations that are deemed necessary should be performed. The claims folder, including a copy of this remand, should be reviewed by the examiner. The examination report should note review of these records, and the VA and private treatment records. Following a complete review of the records, the examiner should provide responses to the following questions: a) Is it at least as likely as not (50 percent or greater probability) that the Veteran’s lower back disorder had its onset in service or is caused by or related at least in part to his active service? b) Is it at least as likely as not (50 percent or greater probability) that the Veteran’s lower back disorder was caused or aggravated (worsened beyond natural progression) by his service-connected right knee and bilateral ankle disabilities? The examiner is advised that the term “at least as likely as not” does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of a certain conclusion as it is to find against it. If the examiner is unable to conduct the required testing or concludes that the required testing is not necessary in this case, he or she should clearly and fully explain why that is so. A clear and thorough rationale for any negative nexus opinion offered should be provided. If the examiner determines that an opinion cannot be provided without resort to speculation, the examiner should explain the inability to provide an opinion, identifying precisely what facts could not be determined. In particular, he/she should comment on whether an opinion could not be rendered because the limits of medical knowledge have been exhausted regarding the etiology of the Veteran’s claim or whether additional information could be obtained that would lead to a conclusive opinion. The examiner must ensure that the requested examination report is responsive to this remand’s directives. Stegall v. West, 11 Vet. App. 268, 271 (1998); 38 C.F.R. § 4.2. 3. After all of the above development has been completed, the Agency of Jurisdiction (AOJ) should readjudicate the issue on appeal. If the benefit sought is not granted, the AOJ should send the Veteran and his representative a Supplemental Statement of the Case, provide an opportunity to respond, and then, if necessary, return the case to the Board for further appellate review. Michael J. Skaltsounis Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J.B. King, Associate 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.