Citation Nr: 20021315 Decision Date: 03/25/20 Archive Date: 03/25/20 DOCKET NO. 12-03 758 DATE: March 25, 2020 REMANDED Entitlement to service connection for a cervical spine disability, to include as secondary to a service-connected low back disability is remanded. REASONS FOR REMAND The appellant is a Veteran who served on active duty from September 1980 to May 1988 and from December 1988 to January 1990. This matter is before the Board on appeal from an August 2010 rating decision. In January 2014, a videoconference Board hearing was held before the undersigned; a transcript is in the record. In September 2014 and February 2018, the matter was remanded for additional development. Entitlement to service connection for a cervical spine disability, to include as secondary to a service-connected low back disability is remanded. The Board finds that further development remains necessary to ensure that the Board’s prior remand instructions are fulfilled. Specifically, the Board finds that the January 2019 examination conducted pursuant to the remand is inadequate. The opinions offered are premised on an inaccurate/incomplete history. The examiner opined, as did the October 2015 examiner, that the cervical spine disability was not incurred in service; the rationale appears to attribute the Veteran’s current neck pathology to an intercurrent postservice injury in the mid-2000s (indicating that most postservice records reviewed were around 2006). The 2019 examiner did not address the diagnostic studies (X-rays and MRIs) showing that cervical spine pathology was documented by, at least, the mid-1990s, about a decade prior to the postservice superimposed injury that required surgical intervention. The previous remand specifically instructed that the examiner must acknowledge the significance of these diagnostic studies, thus the remand instructions were not fulfilled, and the examination/opinion is inadequate for rating purposes. Furthermore, when a veteran puts forth a secondary service connection theory of entitlement, the medical opinion evidence of record must address whether a service-connected disability either caused or aggravated the claimed disability at issue. The January 2019 examiner did not adequately address whether the Veteran’s cervical spine disability was aggravated by her service-connected low back disability. The opinion is therefore non-responsive to the Board’s February 2018 remand instructions, and a remand for corrective action is necessary. See Stegall v. West, 11 Vet. App. 268 (1998). The matter is REMANDED for the following action: The AOJ should arrange for the Veteran’s claims file to be forwarded to an orthopedist for review, and an advisory medical opinion that responds to the following [if further examination of the Veteran is deemed necessary for any opinion sought, such should be arranged]; (a.) Identify (by diagnosis) each cervical spine disability entity shown by the record during the pendency of the instant claim. (b.) Identify the likely etiology for each cervical spine disability entity diagnosed. Specifically, is it at least as likely as not (a 50% or better probability) that it was incurred in service, to include as due to a documented fall (to which her service-connected low back disability is attributed) or cervical spine complaints noted therein? (c.) If the response to (b) is no, then is it at least as likely as not that the diagnosed cervical spine disability was caused or aggravated (the opinion must address aggravation) by the Veteran’s service-connected low back disability? The consulting orthopedist must explain the rationale for all opinions. The rationale should acknowledge that the Veteran fell in service (the event to which her low back disability is attributed) and the cervical complaints noted therein. The provider must specifically acknowledge the significance of the diagnostic studies that reflect cervical spine degenerative changes were shown in the mid-1990s (long prior to the injury which required surgical treatment approximately a decade later). GEORGE R. SENYK Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Schechner, 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.