Citation Nr: 21000915 Decision Date: 01/06/21 Archive Date: 01/06/21 DOCKET NO. 15-12 431 DATE: January 6, 2021 REMANDED Entitlement to service connection for a back disability, to include as secondary to service-connected bilateral plantar fasciitis, is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Army from September 1990 to January 1999. The above issue was previously before the Board of Veterans’ Appeals (Board) in June 2018, when it was remanded for additional development. It was remanded again in April 2020, after the March 2019 VA opinion obtained pursuant to the first remand was found inadequate. The Veteran was previously represented by a private attorney in connection with other claims. Representation of the Veteran on this claim is now with Texas Veterans Commission. 1. Entitlement to service connection for a back disability is remanded. Unfortunately, it is necessary to remand this case once more for an additional medical opinion. The medical opinions provided in this case have been characterized by vagueness and conclusory statements, despite the Board’s repeated instructions to cite specific evidence. The opinions have not addressed the Veteran’s lay statements reporting continuous back pain after 1996. There has not been substantial compliance with the Board’s prior remand instructions, and the Veteran is thus entitled to a third remand. See Stegall v. West, 11 Vet. App. 268 (1998). The Board notes the scarcity of medical evidence in the record; the Veteran has said that she did not seek medical treatment for many years after leaving service, despite claiming continuous back pain. Because of this, the Board finds that a new in-person examination is necessary to adequately assess the Veteran’s disability. The matters are REMANDED for the following action: 1. Conduct a new examination, with an appropriate clinician who has not previously provided an opinion in this case. Based on the examination and a review of the record, the examiner should answer the following: a) Does the Veteran have any chronic spine or other back disability in addition to, or in combination with, scoliosis? If so, identify each of these disabilities and provide opinions regarding their etiology. b) The March 2019 VA examiner characterized the Veteran’s scoliosis as a congenital disease. Is there clear and unmistakable evidence (obvious, manifest, and undebatable) showing that the Veteran’s scoliosis pre-existed service? i. The examiner is requested to identify any clear and unmistakable evidence with specificity. c) If the Veteran’s scoliosis is pre-existing, does the evidence clearly and unmistakably show that the disorder was not aggravated by service or that any increase in disability (pain) was due to the natural progression of the disease? For the purpose of this question, aggravation is defined as a chronic worsening of the underlying condition versus a temporary flare-up of symptoms beyond its natural progression i. Specifically address the possibility that marching while carrying heavy objects during service aggravated the Veteran’s scoliosis. ii. Discuss the severity of the Veteran’s scoliosis, and the level of pain that would typically be associated with this disability in the absence of aggravation. iii. The examiner is requested to identify any clear and unmistakable evidence with specificity. d) Specifically address the Veteran’s testimony that she has experienced continuous back pain in the years following service, and her explanation for why she did not seek treatment. See January 2014 Notice of Disagreement e) Clarify whether Trendelenburg gait is the only way a foot disability could affect the back. a. If not, discuss the likelihood that the Veteran’s gait or other effects of her bilateral plantar fasciitis caused or aggravated her low back disability. f) A complete rationale must be provided for every opinion or conclusion expressed. If an opinion cannot be provided, the examiner must indicate why. 2. The RO should review the medical opinions obtained and ensure that they comply with these directives and undertake corrective action to correct any deficiencies before returning the case to the Board. DELYVONNE M. WHITEHEAD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Shermila Sundquist 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.