Citation Nr: 21000376 Decision Date: 01/05/21 Archive Date: 01/05/21 DOCKET NO. 13-09 522A DATE: January 5, 2021 REMANDED Entitlement to service connection for a neck disability, to include as secondary to a service-connected disability, is remanded. Entitlement to service connection for a back disability, to include as secondary to a service-connected disability, is remanded. Entitlement to a total disability rating based upon individual unemployability (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1983 to March 1987. The Board most recently remanded the claims in March 2019 claims for new opinions because VA examinations of record were inadequate. The opinions obtained following the March 2019 remand did not comply with the remand directives and are still inadequate. Thus, another remand is required. Stegall v. West, 11 Vet. App. 268 (1998). 1. Entitlement to service connection for a neck disability, to include as secondary to a service-connected disability, is remanded. 2. Entitlement to service connection for a back disability, to include as secondary to a service-connected disability is remanded. The January 2020 and July 2020 VA examinations did not substantially comply with the remand directives in addressing the (i) notation of recurrent back pain on the Report of Medical History at separation from service and the Veteran’s report of back pain since the 1980s, and; (ii) the Veteran’s credible report of neck pain in service when he struck his head and pain since service. Further, the January 2020 and July 2020 VA examinations only focused on degenerative disc disease (DDD) occurring as natural to aging process. On remand the examiners should also opine on the likelihood the DDD resulted from a traumatic injury. The July 2020 examiner also focused on a June 2010 VA treatment record report that the Veteran injured his neck from a fall while at work. However, the examiner did not discuss or appear to consider a December 2010 neurosurgery consult record where the Veteran reported having neck pain for 20 years that has progressively worsened. The claims must be remanded again. Stegall, 11 Vet. App. at 268. The opinions on remand must also address whether any back or neck disability is caused or aggravated by the now service-connected right and left knee disabilities. 3. Entitlement to TDIU is remanded. The TDIU claim is inextricably intertwined with the claims being remanded and adjudication of that issue will be deferred until the issue of service connection is decided. The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination with an appropriate VA examiner, to determine the likely etiology of the neck and back disabilities. Copies of all pertinent records must be made available to the examiner. Based on the examination and review of the record, the examiner is asked to answer the following questions: (a) Is it at least as likely as not (50 percent probability) that any currently diagnosed knee condition was incurred in or is otherwise related to service? In rendering the opinion, the examiner must comment on the following: (i) notation of recurrent back pain on the Report of Medical History at separation from service and the Veteran’s report of back pain since the 1980s; (ii) the Veteran’s credible report of neck pain in service when he struck his head and pain since, and; (iii) December 2010 neurosurgery consult where the Veteran reported having neck pain for over 20 years. (b) If (a) is answered no, is it at least as likely as not (probability of at least 50 percent) that any currently diagnosed knee condition has been (i) caused or (ii) aggravated by any of the Veteran’s service-connected disabilities, including right and left knee disabilities and plantar fasciitis? The examiner is informed that aggravation here is defined as any increase in disability. If aggravation is present, the clinician should indicate, to the extent possible, the approximate level of disability (baseline) before the onset of the aggravation A complete rationale must be provided for all opinions, citing to supporting factual data and medical literature, as appropriate. If the examiner cannot provide an opinion without resort to speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training) and note what, if any, additional evidence would permit such an opinion to be made. 2. After the above development, and any additionally indicated development, has been completed, readjudicate the issues on appeal, including the inextricably intertwined issue of entitlement TDIU M.E. Larkin Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. G. Perkins, 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.