Citation Nr: 20032948 Decision Date: 05/12/20 Archive Date: 05/12/20 DOCKET NO. 20-12 469 DATE: May 12, 2020 ORDER Entitlement to service connection for a lower back condition is granted. REMANDED Entitlement to service connection for dysmenorrhea, as secondary to service-connected idiopathic thrombocytopenic purpura (ITP), is remanded. Entitlement to service connection for adenomyosis, as secondary to service-connected ITP, is remanded. FINDING OF FACT Resolving all reasonable doubt in favor of the Veteran, the Veteran’s low back condition is etiologically related to her active military service. CONCLUSION OF LAW The criteria for entitlement to service connection for lower back condition have been met. 38 U.S.C. §§ 1110, 1154, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from January 1994 to December 1997. This case comes before the Board of Veterans’ Appeals (Board) on appeal from September 2018 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). Entitlement to service connection for a lower back condition. The Veteran contends that her current low back condition is etiologically related to her active duty service; specifically, from a motor vehicle accident that occurred during active duty in 1997. Generally, to prevail on a direct service connection claim, there must be competent evidence of (1) a current disability, (2) in-service incurrence or aggravation of a disease or injury, and (3) a nexus between the in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009); 38 U.S.C. § 1110, 1131; 38 C.F.R. § 3.303(a). Service treatment records (STRs) note that the Veteran was involved in a motor vehicle accident, where she initially had back pain which has since resolved. Post-service VA and private treatment records reflect continuous complaints and treatment from low back pain, with multiple visits to a chiropractor for relief. In November 2019, the Veteran submitted a private medical opinion from her treating chiropractor, who noted awareness of the Veteran’s involvement in a motor vehicle accident during active duty in 1997; and diagnosed the Veteran with low back pain, muscle spasms of back, and somatic dysfunction of lumber region. After reviewing the Veteran’s medical records and after personally examining the Veteran since her onset of treatment in February 2019, the chiropractor provided that it is his professional opinion that it is as likely as not that the Veteran’s current symptoms are a result of her motor vehicle accident during military service. The chiropractor rationalized that in his personal experience and in medical literature it is known that motor vehicle accidents can have long lasting consequences leading to chronic conditions. See Medical Treatment Record – Non-Government Facility, November 2019. In January 2020, the Veteran was afforded a VA examination and opinion to determine the current nature and etiology of her claimed low back condition. Upon examination, the examiner diagnosed the Veteran with degenerative arthritis of the spine; however, provided an unfavorable opinion as to this condition being etiologically related to the Veteran’s active duty service. The examiner rationalized that there is no treatment found for diagnosis or treatment specifically for claimed back condition during service, with no mention of back injury during in-service motor vehicle accident in December 1997. Nevertheless, the Board finds this opinion to be inadequate, as the examiner’s rationale is in direct contradiction with the evidence of record, as review of the Veteran’s STRs clearly reflects the notation for back pain due to a motor vehicle accident, even though it was further noted that it had since resolved. Additionally, the Board notes that the examiner failed to address and/or provide discussion on the Veteran’s positive private opinion submitted in November 2019 (the examiner merely mentioned and restated the private opinion). Therefore, given this, the Board assigns this opinion little, if any, probative weight. Conversely, the Board finds the November 2019 private opinion to be highly probative, as the chiropractor’s opinion is predicated on personally treating the Veteran for an extended period, coupled with support of pertinent evidence and medical literature. Therefore, as the probative evidence of record is for the Veteran’s claim, or at the very least in relative equipoise, and resolving all reasonable doubt in favor of the Veteran, the Board finds that service connection for low back condition is warranted; and the claim is granted. Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 U.S.C. § 5207; 38 C.F.R. § 3.102, 3.310. REASONS FOR REMAND Entitlement to service connection for dysmenorrhea and adenomyosis, as secondary to service-connected ITP, is remanded. The Veteran contends that her current dysmenorrhea and adenomyosis was proximately caused and/or aggravated by her service-connected ITP. As an initial matter, the Board notes that the Veteran, to date, has not been provided with a VA examination or opinion addressing the nature and etiology of her claimed conditions. However, in October 2017, the Veteran provided a private DBQ examination, which noted diagnoses of adenomyosis and dysmenorrhea, but no opinion as to the etiology of these conditions was provided. Therefore, the Board finds that the Veteran should be afforded a VA examination and/or provided a VA medical opinion addressing the etiology of the Veteran’s current conditions as it relates secondary to her service-connected ITP, prior to adjudication of the claim. See McLendon v. Nicholson, 20 Vet. App. 79, 81-82 (2006). Accordingly, a remand is necessary to address the matters discussed above. The matters are REMANDED for the following action: 1. Request the Veteran to identify all medical providers (VA and private) from whom she has received treatment for her dysmenorrhea and adenomyosis and obtain any outstanding records and associate them with the Veteran’s claims file. 2. After associating all newly acquired records with the claims file, schedule the Veteran for VA examinations and/or provide VA medical opinions by appropriate clinicians to determine the nature and etiology of the Veteran’s dysmenorrhea and adenomyosis. The entire claims file, including a copy of this remand, must be made available to the examiner, and note review of the record in the examination report. Any indicated tests or studies should be performed, and all material relevant evidence should be discussed. All pertinent medical complaints, symptoms, and clinical findings must be reported in detail. Following complete review of the record, the examiner must address the following: (a) Opine whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s dysmenorrhea and/or adenomyosis was incurred in or is otherwise attributable to service. In setting forth this opinion, the examiner must consider, and comment upon as necessary, the submitted internet excerpts (see Medical Treatment Record – Non-Government Facility, February 2020). (b) Opine whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s dysmenorrhea and/or adenomyosis was caused or aggravated (beyond the natural progression) by a service-connected disability (as listed in a November 2018 rating decision), to specifically include her service-connected ITP. Please note: the examiner must address both causation and aggravation in providing the opinions requested above. Additionally, the examiner must discuss the submitted internet excerpts (see Medical Treatment Record – Non-Government Facility, February 2020). If the opinion is that a service-connected disability or combination of service-connected disabilities aggravated either condition, the examiner should specify, so far as possible, the degree of disability resulting from such aggravation. Any opinion should include a detailed rationale. The examiner should consider the entire claims file, and discuss the Veteran’s lay statements regarding the nature, onset, and chronicity of symptoms. The examiner is advised that the Veteran is competent to report symptoms, and that her reports must be considered in formulating the requested opinion. If the examiner is unable to offer the requested opinion, it is essential that the examiner offer a rationale for the conclusion that an opinion could not be provided without resorting to speculation, together with a statement as to whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. See Jones v. Shinseki, 23 Vet. App. 382. (2010). C. M. COLLINS Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. Hodges, 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.