Citation Nr: 20005376 Decision Date: 01/22/20 Archive Date: 01/22/20 DOCKET NO. 16-38 323 DATE: January 22, 2020 REMANDED Entitlement to service connection for a low back disorder, to include degenerative disc disease and spinal stenosis, is remanded. REASONS FOR REMAND The Veteran, who is the appellant, had verified active duty for training with the Army National Guard from June 1991 to August 1991 and from June 1992 to August 1992, along with service in the National Guard from October 1990 to October 1996. The Veteran contends that he injured his back during his period of service in the National Guard, to include a period of basic training and that his current back disorder has continued since that time. A review of the Veteran’s service treatment records reveals that he was seen with complaints of back pain in February 1991. A diagnosis of low back pain was rendered at that time. In an April 1991 letter to the North Carolina Army National Guard, the Veteran’s physician, G. H. M.D., indicated that he had treated the Veteran several times over the past few months for a lower lumbosacral sprain which was somewhat prolonged in nature. He noted that at that point, due to his adolescent growth, the Veteran was going to be predisposed towards recurrent sprains which might preclude him from participating in strenuous activities such as that involved with the National Guard. He noted that it might be in both the Veteran’s and the Guard’s best interest to consider this when forming plans about his long-term participation in the National Guard. On his April 1996 report of medical history, the Veteran checked the “yes” box when asked if he had recurrent back pain. The Veteran was noted to have been in a car accident in 1994 and to have sustained back injury. Both the Veteran and his spouse have reported and testified as to his having had continuous back problems since his period of National Guard service, with the Veteran’s wife indicating that the Veteran was a wearing a back brace in 1994 when she met him. The Veteran has been diagnosed as having degenerative disc disease. The Board notes that the Veteran was afforded a VA examination in August 2013, at which time a diagnosis of degenerative disc disease and stenosis was made, with the examiner indicating that the claimed condition, which clearly and unmistakably existed prior to service, was clearly and unmistakably not aggravated beyond its natural progression by an in service, injury, illness, or event. As rationale, the examiner indicated that there was no evidence in the service medical records which indicated that the Veteran’s lumbar spine condition was aggravated beyond its natural progression due to military service as there was no evidence indicating additional injury while in the military. The examiner observed that there was documentation of low back pain for one to two months in 1991; however, there was no documentation of low back pain or treatment for low back pain aggravation from 1991 to separation examination in 1996. The examiner further stated there was no documented back pain or treatment post military service from 1996 to 2010 indicating chronic or recurrent pain. The examiner also observed that in the HPI, it was noted that the Veteran’s back pain started after a motor vehicle accident. The examiner further noted that the Veteran began to experience pain after performing yardwork in April 2010. The examiner also stated that there was no documentation from an orthopedic specialist indicating worsening of the condition due to military versus having an exacerbation of back pain which subsided. Thus, there was no evidence to support the claim of progression due to military service. Unfortunately, the examiner did not address the Veteran’s contentions nor were the statements from the Veteran’s spouse of record. Furthermore, the examiner did not address the April 1991 statement from Dr. H. The examiner also did not address the findings of a normal spine and lower extremities on the Veteran’s October 1990 enlistment examination. In addition, no dates of periodic ACDUTRA or inactive duty for training with regard to the Veteran’s National Guard service are of record. Given the above, additional development is warranted. The matters are REMANDED for the following action: 1. Undertake appropriate development to obtain all outstanding VA and/or private treatment records related to the Veteran's outstanding claim. If any requested records are not available, the record should be annotated to reflect such and the Veteran notified. 2. Exhaust all efforts to obtain the Veteran's service personnel and medical records pertaining to his service in the National Guard and add them to the claims file. Verify all periods of ACDUTRA and INACDUTRA service. 3. Schedule the Veteran for the appropriate VA examination to assist in determining the nature and etiology of any low back disorder. The entire record should be made available to the examiner for review. All necessary tests should be performed. Provide the examiner with all identified specific dates of ACDUTRA and INACDUTRA. The examiner is requested to offer the following opinions: a) Opine whether it is at least as likely as not (a 50 percent or greater probability) that any current low back disability or residuals thereof are related to an in-service injury during a verified period of ACDUTRA or INACDUTRA. (b) Opine whether any low back injury, including any lumbar strain, clearly and unmistakably preexisted a verified ACDUTRA or INACDUTRA period of service. (c) If it is determined that a low back disability clearly and unmistakably preexisted a verified period of ACDUTRA or INACDUTRA, the examiner is asked to opine whether the preexisted disability clearly and unmistakably was NOT aggravated by (i.e., permanently worsened beyond the natural progression) by or during a confirmed period of ACDUTRA, or a preexisting injury that was aggravated by or during a confirmed period of INACDUTRA. If aggravation is found, the examiner must provide the basis for the finding that a low back disability preexisted service, specifically address the baseline severity of the disability before it was aggravated by service, and identify any supporting clinical records. The examiner is advised that the Veteran is competent to report his symptoms and history and that such report must be acknowledged and considered in formulating any opinion. The examiner must provide a rationale for all opinions offered. If the examiner feels that the requested opinion cannot be rendered without resorting to speculation, he/she should state whether the need to speculate is caused by a deficiency in the state of general medical knowledge (i.e. no one could respond given medical science and the known facts), by a deficiency in the record (i.e. additional facts are required), or by the examiner himself/herself (because he/she does not have the needed knowledge or training). K. Parakkal Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Department of Veterans Affairs 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.