Citation Nr: 21000398 Decision Date: 01/05/21 Archive Date: 01/05/21 DOCKET NO. 13-17 196 DATE: January 5, 2021 REMANDED Entitlement to service connection for a neck disability, including as secondary to service-connected post-traumatic stress disorder (PTSD), is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1990 to June 1991. She served honorably in the United States Navy with additional service in the Navy Reserve. The Board thanks the Veteran for her service to our country. This case originally came to the Board of Veterans’ Appeals (Board) on appeal from a May 2010 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Seattle, Washington. This matter was previously before the Board in April 2015, June 2017, December 2017, and September 2019. In April 2015, it was remanded to verify the Veteran’s service dates and for a VA examination pertaining to her claimed neck disability. In June 2017, it was remanded so that Social Security Administration records could be associated with the claims file, for an addendum medical opinion regarding direct service connection, and for a secondary service connection opinion regarding PTSD. In December 2017, it was remanded for an addendum medical opinion regarding secondary service connection. It was remanded in September 2019 to adequately address the matter of aggravation. The Board regrets further delay but another remand is necessary in order to properly adjudicate the claim. The examiner was asked to provide an opinion regarding aggravation of the Veteran’s neck disability by her service-connected PTSD. While the examiner opined that the there was no aggravation, the examination did not consider the Veteran’s lay statement and used the same language for proximate causation for aggravation, rendering the opinion inadequate. Barr v. Nicholson, 21 Vet. App. 303, 310-11 (2007). Additionally, the Board emphasizes that with respect to aggravation, per a recent decision from the Court of Appeals for Veterans Claims, “any incremental increase in disability any additional impairment of earning capacity in non-service-connected disabilities resulting from service-connected conditions regardless of its permanence” constitutes aggravation. Ward v. Wilkie, 31 Vet. App. 233, 240 (2019). As such, the examiner is advised that his or her inquiry is not limited to the definition of aggravation as a permanent worsening of the condition beyond its natural progression. The matter is REMANDED for the following action: 1. Obtain and outstanding VA treatment records. 2. With any necessary assistance from the Veteran, obtain any relevant outstanding private treatment records. 3. Then obtain and addendum opinion from an examiner other than the August 2015, August 2017, January 2018, and January 2020 VA examiner, to address the following: Is it at least as likely as not (a 50 percent or greater probability) that the Veteran’s neck disability has been aggravated (i.e. worsened in degree of severity) by her service-connected PTSD disability? Please note that the worsening/aggravation need not be permanent. In answering this question please address October 2012 VA Pain Service consultation noting the Veteran’s response as to the cause of her pain as stating that she was not sure, but “know[s] part of it is physical and part mental. Please also note there is no temporal requirement that the primary condition be service-connected, or even diagnosed, at the time the secondary condition is incurred, and reliance on this fact will render the opinion inadequate. A comprehensive rationale must be furnished for this opinion. If the examiner is unable to provide a medical opinion, then he or she should provide a rationale for that conclusion, to specifically include a statement as to whether there is any 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. MICHAEL LANE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. J. Rogers, 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.