Citation Nr: 21001847 Decision Date: 01/12/21 Archive Date: 01/12/21 DOCKET NO. 13-24 657 DATE: January 12, 2021 REMANDED Service connection for a cervical spine disorder, to include as secondary to service connected lumbar disc disease is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1986 to May 1988. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a January 2012 rating decision. The Board previously remanded the matter in November 2017 and June 2019 for further development. 1. Service connection for a cervical spine disorder is remanded. The record does not appear to contain a medical nexus opinion that addresses the Veteran’s contention that her current cervical spine disorder is related to the same 1986 injury from jumping off a truck in service that resulted in a herniated disc in her lumbar spine in service. The Board found in the June 2019 remand that while the December 2011 VA examiner checked a box indicating that an opinion was being provided regarding direct service connection, the scant rationale accompanying the opinion addressed only secondary service connection and, as such, a new VA opinion was necessary. A VA medical opinion was obtained in November 2019. The examiner opined it is less likely as not that the Veteran’s current cervical spine disorder is incurred in or caused by the claimed in-service injury, event, or illness. Service treatment records were found to be negative for any complaints of neck pain or injury to the neck during active duty service. The examiner determined a nexus is not established. Although the examiner indicated that the Veteran’s medical records and statements were reviewed, the examiner failed to specifically address the Veteran’s contentions in the opinion as requested in the previous remand. As such, the opinion is inadequate, and another opinion is necessary. The matter is REMANDED for the following action: 1. The Veteran should be given the opportunity to identify any outstanding private or VA treatment records relevant to the claim on appeal. After obtaining any necessary authorization from the Veteran, all outstanding records should be obtained, to include updated VA treatment records. For private treatment records, make at least two (2) attempts to obtain records from any identified sources. If any such records are unavailable, inform the Veteran and her representative and afford her an opportunity to submit any copies in her possession. For federal records, all reasonable attempts should be made to obtain such records. If any records cannot be obtained after reasonable efforts have been made, issue a formal determination that such records do not exist or that further efforts to obtain such records would be futile, which should be documented in the claims file. The Veteran must be notified of the attempts made and why further attempts would be futile, and allowed the opportunity to provide such records, as provided in 38 U.S.C. § 5103A(b)(2) and 38 C.F.R. § 3.159(e). 2. Following the receipt of outstanding records, obtain an addendum opinion from an appropriate examiner regarding the nature and etiology of the Veteran’s cervical spine disorder. The need for another examination is left to the discretion of the medical professional offering the addendum opinion. The examiner should answer the following question: (Continued on the next page)   Is it at least as likely as not (50 percent probability or greater) that the Veteran’s cervical spine disorder is related to an in-service disease or injury, to include an injury from jumping off a truck in 1986 and subsequent discectomy? The examiner discuss the significance, if any, of the Veteran’s descriptions of the in-service event in July 1991 and August 1993 VA examinations of the spine. The examiner must consider the Veteran’s lay statements regarding the onset and continuity of his symptoms, to include his reports that he began experiencing sleep difficulties in service. A complete rationale should be given for each opinion expressed. In this regard, a discussion of the facts and medical principles involved would be considerable assistance to the Board. KRISTY L. ZADORA Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. M. Donahue Boushehri, 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.