Citation Nr: 20034461 Decision Date: 05/18/20 Archive Date: 05/18/20 DOCKET NO. 15-11 733 DATE: May 18, 2020 REMANDED Entitlement to service connection for a back condition, to include as secondary to service-connected bilateral knee and hip disabilities, is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1981 to March 1985. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a February 2013 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). This matter was previously before the Board in September 2018 when it was remanded for issuance of a supplemental statement of the case (SSOC) in light of the additional evidence added to the record since the last statement of the case and the Veteran’s request that such evidence be initially reviewed by the agency of original jurisdiction (AOJ). In this case, the Veteran asserts that his back condition had its onset in service or is related on a secondary basis to his service-connected bilateral knee and hip disabilities. Service treatment records note multiple complaints by the Veteran regarding back pain. VA medical records and examinations note the Veteran has diagnoses of degenerative disc disease with anterior osteophytes at T12-L1/degenerative arthritis of the spine and chronic low back syndrome. The Veteran has had two VA examinations regarding his back condition, including opinions regarding whether they are related to his service-connected disabilities. In October 2012, the examiner opined that the Veteran’s current back condition was less likely than not related to his service-connected bilateral knee conditions because the Veteran “has past history of in-service motorcycle accidents and post service motor vehicle accidents in 2008 and 2009 with continued treatment since for neck and low back pain.” However, the examiner did not provide any more supporting facts or evidence for this opinion, nor address the Veteran’s multiple in-service complaints regarding back pain. In addition, the examiner appears to base the negative nexus opinion on the Veteran’s post-service motor vehicle accidents but did not adequately explain how or why this conclusion was reached, especially in light of the Veteran’s in-service reports of back-related symptoms. In July 2019, the Veteran was provided an additional VA back examination. The examiner provided opinions regarding whether the Veteran’s back condition is related on a secondary basis to his service-connected bilateral knee and hip disabilities. The examiner opined that the medical literature did not support that the Veteran’s mild antalgic gait, due to the conditions in his hips, knees, and ankles, would cause or aggravate the degenerative arthritis his spine beyond its natural progression. In addition, the examiner stated that an abnormal gait can affect the spine if it is both severe and prolonged for years. The examiner repeated this same rationale for each of the Veteran’s distinct bilateral knee and hip conditions. However, the examiner did not provide sufficient rationale for the opinion as he did not indicate what evidence of record supported his conclusion that the Veteran’s abnormal gait was neither severe nor prolonged. Furthermore, the opinion did not address the Veteran’s in-service reports of back pain nor his lay statements. In addition, the Board notes that the Veteran was awarded the parachute badge while serving in the Air Division of the United States Army. During his July 2019 VA examination, he stated that the onset of his back pain was in 1981, during his time as a paratrooper, when he would jump out of airplanes, land and march with heavy equipment for several miles. He stated that since the onset his back pain continued to increase in severity due to the jumps and marches with heavy equipment. As such, an opinion regarding direct connection that addresses whether the Veteran’s back condition is due to the rigors of service as a paratrooper is warranted. Based on the foregoing, the Board finds the October 2012 and July 2019 opinions inadequate. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). Thus, the Board finds that a remand is necessary in order to obtain addendum opinions and an examination (or telehealth interview, review of the record, etc., if an in-person examination is not feasible) regarding direct and secondary service connection that addresses the above deficiencies. The matters are REMANDED for the following action: Arrange for an appropriate clinician to provide an opinion regarding the etiology of the Veteran’s back condition. It is up to the discretion of the selected clinician as to whether an in person examination of the Veteran is required to provide the opinion. The examiner is requested to provide opinions regarding: (a) whether it is at least as likely as not (i.e. a 50 percent probability or greater) that the Veteran’s back condition had its onset during military service, or is otherwise related to his active duty service. The examiner should address the Veteran’s statements regarding onset of back pain due to the rigors of his duties as a paratrooper, including jumping and marching with heavy equipment, as well as his in-service complaints of back pain in the opinion provided. In addition, the examiner may not dismiss the Veteran’s lay statements as to symptoms solely on the basis that they are not recorded in contemporaneous medical records. (b) whether it is at least as likely as not that the Veteran’s back condition is proximately due to, or aggravated by, his service-connected bilateral knee and hip disabilities and any corresponding altered gait. The secondary service connection opinion must address both causation and aggravation to be deemed adequate. The examiner is advised aggravation means an increase in the severity of the underlying disability beyond its natural progression. If aggravation is found, the examiner should attempt to describe the baseline level of severity of the back condition prior to aggravation by the service-connected disability. (Continued on the next page)   The examiner must provide a complete rationale for all opinions. If an examiner cannot provide an opinion without resorting to speculation, it must be so stated, and he or she must provide the reasons why an opinion would require speculation. The examiner should consider any lay statements of record and may not disregard lay statements solely on the basis that they are not recorded in contemporaneous medical records. If there is a medical basis to support or doubt the history provided by the lay statements, the examiner should provide a fully reasoned explanation. M. HYLAND Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Ariasaif, 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.