Citation Nr: 20056463 Decision Date: 08/26/20 Archive Date: 08/26/20 DOCKET NO. 18-51 207 DATE: August 26, 2020 REMANDED Entitlement to service connection for a low back disorder is remanded. Entitlement to service connection for a left hip disorder, to include as secondary to a low back disorder, is remanded. Entitlement to service connection for a right hip disorder, to include as secondary to a low back disorder, is remanded. Entitlement to service connection for a left leg disorder, to include as secondary to a low back disorder, is remanded. Entitlement to service connection for a right leg disorder, to include as secondary to a low back disorder, is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1959 to October 1962. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an August 2018 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). The Board remanded the case for further development in March 2019. The case has since been returned to the Board for appellate review. Upon review, the Board finds that additional development is needed prior to adjudication of the claims. An October 1959 enlistment examination noted that the Veteran had an abnormal spine. Specifically, he was found to have postural dorsolumbar scoliosis that was not considered disabling. The Veteran was afforded a VA examination in December 2019 in connection with his claim. The examiner diagnosed the Veteran with degenerative arthritis of the spine, but he opined that the disorder is less likely as not due to his military service. He acknowledged that the enlistment examination documented scoliosis, but noted that there was no documentation of such a disorder on other imaging or examinations. He explained that a MRI is more sensitive to the detection of scoliosis than a physical examination and that adolescent scoliosis does not spontaneously resolve. Thus, the examiner stated that the absence of scoliosis on a MRI rules out the aggravation of scoliosis, which has been absent on available imaging. Given the fact that there is no subsequent documentation of scoliosis, he indicated that the original examination finding was most likely made in error. The examiner also found that the Veteran's contention that his back was injured in service is not supported by the service treatment records. Nevertheless, the December 2019 VA examiner did not specifically address the Veteran’s claim that his current back disorder was caused by the physical demand in basic training and carrying heavy loads related to his duties a combat engineer, as directed in the prior remand. Therefore, the Board finds that an additional VA medical opinion is needed. The Board also finds that the issues of entitlement to service connection for a left disorder, a right hip disorder, a right leg disorder, and a left leg disorder are inextricably intertwined with the Veteran’s claim for service connection for a low back disorder. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (noting that two or more issues are inextricably intertwined when the adjudication of one issue could have significant impact on the other issue). The matters are REMANDED for the following action: 1. The Agency of Original Jurisdiction (AOJ) should request that the appellant provide the names and addresses of any and all health care providers who had provided treatment to the Veteran for his back, legs, and hips. After acquiring this information and obtaining any necessary authorization, the AOJ should obtain and associate these records with the claims file. The AOJ should also secure any outstanding VA medical records. 2. After completing the foregoing development, AOJ should refer the claims file to the December 2019 VA examiner (or another VA examiner if he is not available) to determine the nature and etiology of any low back disorder that may be present. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran’s service treatment records, post-service medical records, and lay assertions. The examiner should note that the Veteran is competent to attest to matters of which he has first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. For any diagnosis identified other than scoliosis, the examiner should state whether it is at least as likely as not that the disorder manifested in service or is otherwise causally or etiologically related to the Veteran’s military service, to include any physical demands during basic training and his duties as a combat engineer. (The term “at least as likely as not” does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find favor of conclusion as it is to find against it.) A clear rationale for the opinion would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. Because it is important “that each disability be viewed in relation to its history[,]” 38 C.F.R. § 4.1, copies of all pertinent records in the Veteran’s claims file, or in the alternative, the claim file, must be made available to the examiner for review. 3. The AOJ should conduct any other development as may be indicated. J.W. ZISSIMOS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K.M. Walker 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.