Citation Nr: 20037558 Decision Date: 06/02/20 Archive Date: 06/02/20 DOCKET NO. 17-11 309 DATE: June 2, 2020 REMANDED Entitlement to service connection for back disability, to include as secondary to service-connected knee disabilities, is remanded. REASONS FOR REMAND The Veteran had active service from October 1977 to October 1981 and from November 1981 to November 1997. He is a veteran of the Gulf War Era and Peacetime. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a June 2016 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO) of the Veterans Benefits Administration (VBA), which is the Agency of Original Jurisdiction (AOJ). This appeal was previously before the Board in December 2018, at which time it was remanded for further development including an addendum opinion as to the etiology of the Veteran’s claimed back disability. The Board’s prior remand directives will be discussed below. The Veteran’s appeal has been returned to the Board for further appellate consideration. 1. Entitlement to service connection for back disability, to include as secondary to service-connected knee disabilities The Veteran contends that he has a current back disability that was incurred in service. He reported in his Substantive appeal (VA Form 9) in February 2017 that he hurt his back several times in service. Alternatively, he contends that his back disability is related to his service-connected knee disabilities. Consequent to the Board’s December 2018 remand, an addendum opinion was obtained in January 2020 addressing the nature and etiology of the Veteran’s low back disability. Pertinently, although the VA examiner found that the Veteran’s low back disability was not proximately due to his service or caused or aggravated by his service-connected knee disabilities, it appears that the latter opinion was based on an inaccurate factual premise. Specifically, while the VA clinician who offered the January 2020 addendum opinion cited to a lack of evidence showing a discrepancy in the lengths of the Veteran’s legs, several VA treatment records note that the Veteran’s left leg was shorter than his right leg after his total left knee replacement surgery. More pointedly, VA treatment records note that the Veteran’s left knee replacement surgery resulted in “pelvic tilt” which may result in low back pain was advised by VA medical personnel to obtain show inserts to account for this leg length discrepancy in order to “avoid a back issue.” In light of above, the Board concludes that another remand is necessary to afford the Veteran an in-person VA examination to determine whether his low back disability is proximately due to his active duty or caused or aggravated by his service-connected knee disabilities, to include the leg length discrepancy secondary to total left knee replacement surgery. To this extent, the Board’s prior remand directives have not been substantially completed. Stegall v. West, 11 Vet. App. 268 (1998). The matters are REMANDED for the following action: 1. The AOJ must obtain and associate with the file all records of VA treatment that are not already part of the record. 2. The AOJ must contact the Veteran and request that he complete a release for any post-service treatment records that are outstanding and pertinent to the issues remanded by the Board that are not already part of the record. In these releases, the Veteran should provide a time period in which he was treated at each facility identified. The AOJ should then obtain the records identified by the Veteran. All records obtained should be associated with the Veteran's file. If any identified and requested records are not available, or if the search for any such records otherwise yields negative results, that fact should clearly be documented in the file, and the Veteran should be informed in writing. 3. The AOJ must request that the Veteran be scheduled for an appropriate VA examination to determine the nature and etiology of his low back condition. The examiner should address the following: a. Identify all low back disabilities present during the period of appeal. b. For each low back disorder identified in part (a), provide an opinion concerning whether such disorder began during active service; manifested within one year after discharge from service (in the case of any currently diagnosed arthritis); or is related to an in-service injury, event, or disease, including the Veteran’s reported back injuries in service. c. For each low back disorder identified in part (a), provide an opinion concerning whether such disorder is at least as likely as not caused by the Veteran’s service-connected knee disabilities, to specifically include his left knee total arthroscopy. d. For each low back disorder identified in part (a), provide an opinion concerning whether such disorder is at least as likely as not aggravated by the Veteran’s service-connected knee disabilities, to specifically include his left knee total arthroscopy. *In addressing parts (c) and (d), the examiner is requested to consider and address the January 9, 2017 treatment note indicating the Veteran’s left leg is shorter than his right leg by 1 cm, and that he needed inserts to avoid a back issue. The examiner should also address the treatment note dated January 31, 2018 indicating that the Veteran’s left leg is approximately ¼ inch shorter than his right leg and this produces low back pain due to compensation when walking. (Continued on the next page)   If the examiner cannot provide an opinion without resorting to mere speculation, this should be so stated along with supporting rationale. In so doing, the examiner shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to the particular question. 4. Thereafter, the AOJ must readjudicate the issue on appeal. If the benefit is not granted to the fullest extent, the Veteran and his private attorney must be furnished with a Supplemental Statement of the Case and be afforded the applicable opportunity to respond. Scott W. Dale Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Debra B. McLoughlin, 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.