Citation Nr: 21002247 Decision Date: 01/13/21 Archive Date: 01/13/21 DOCKET NO. 10-00 871 DATE: January 13, 2021 REMANDED Entitlement to service connection for a lumbar spine disability, to include as secondary to a service-connected left knee disability, is remanded. Entitlement to service connection for a cervical spine disability, to include as secondary to a service-connected left knee disability, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Marine Corps from July 1989 to June 1991. These claims were previously denied by the Board in a July 2019 decision. The Veteran appealed to the Court of Appeals for Veterans Claims (Court) which, pursuant to a Joint Motion for Remand (JMR), vacated and remanded the claims for further development in an August 2020 order. Given the guidance provided in the JMR, the Board finds that remand is again needed before a decision may be rendered on the claims. See Stegall v. West, 11 Vet. App. 268 (1998). 1. Entitlement to service connection for a lumbar spine disability, to include as secondary to a service-connected left knee disability, is remanded. 2. Entitlement to service connection for a cervical spine disability, to include as secondary to a service-connected left knee disability, is remanded. As noted in the JMR, the Veteran submitted a release for private medical records in November 2009. It does not appear that any efforts have been made to obtain the identified records. As such, they should be sought upon remand. When these claims were previously before the Board in August 2016, the Agency of Original Jurisdiction (AOJ) was directed to obtain a VA examination by an orthopedist/orthopedic surgeon. VA neck and back examinations were conducted in February 2017 by a doctor specializing in family medicine. Following an October 2017 Board remand for an addendum opinion, the same clinician provided another opinion in January 2018. As noted in the JMR, because the clinician was not an orthopedist/orthopedic surgeon, the August 2016 remand directives have not been substantially complied with and a new examination must be obtained upon remand by an orthopedist/orthopedic surgeon. See Stegall, 11 Vet. App. 268. The Veteran has contended that his cervical and lumbar spine disabilities are related to his active service or that they are secondary to his service-connected left knee disability. Specifically, he has maintained that his service-connected left knee disability causes him to favor his right leg, which produces uneven weight-bearing during ambulation, thus causing his current back and neck problems, diagnosed as spondylosis of the lumbar spine and degenerative disc disease (DDD) of the cervical spine. As noted in the JMR, the Veteran also stated to a June 2006 VA examiner that he believed that carrying heavy packs during service caused his back problem. As such, the new medical opinion obtained upon remand should discuss all theories of entitlement put forward by the Veteran. The matters are REMANDED for the following action: 1. Obtain records of private treatment by Dr. Farber of the Gateway Medical Center from November 2009 to the present and associate them with the claims file. Acquire any necessary releases from the Veteran and document all attempts to obtain the records in the claims file. 2. Schedule the Veteran for a VA examination with an orthopedist/orthopedic surgeon (and specifically not the March 2012/February 2016 VA examiner) to ascertain the nature and etiology of the Veteran’s cervical and lumbar spine disabilities. The examiner should review the entire record and note that such review took place. The examiner is asked to address the following: (a.) Identify any current diagnoses or symptoms causing functional impairment in the cervical spine and lumbar spine; (b.) Determine whether it is at least as likely as not (50 percent probability or greater) that any cervical spine or lumbar spine disability was caused during active service, to include from carrying heavy packs; (c.) Determine whether it is at least as likely as not (50 percent probability or greater) that any cervical spine or lumbar spine disability was caused or aggravated (i.e., worsened beyond natural progression) by the Veteran’s service-connected left knee disability, to include from favoring his right leg, which produces uneven weight-bearing during ambulation; (d.) In determining whether his claimed conditions are aggravated by the service-connected disability, discuss a baseline level of severity of the claimed condition established by medical evidence created before the onset of aggravation or by the earliest medical evidence created at any time between the onset of aggravation and the receipt of medical evidence establishing the current level of severity. (e.) The examiner is asked to specifically discuss the following and to reconcile the differing opinions of record: i. The self-reported motor vehicle accidents occurring in 1993, 1996, late 2010-early 2011, and November 2014; ii. The December 5, 2008, VA treatment record which reflected that the Veteran’s shifting his weight off of his left knee and tending to twist with a torsional movement of the low back was consistent with where his lumbar pain was and which noted an impression of chronic neck and back pain that appeared to be principally due to a combination of degenerative arthritis, DDD, and overuse type syndromes; iii. The June 2006 VA examination and opinion; iv. The March 2012 VA examination and opinion; v. The February 2016 VA examination and opinion; vi. The February 2017 addendum opinion; and vii. The January 2018 addendum opinion; (f.) The clinician is asked to provide a rationale and to explain the reasons behind any opinions expressed and conclusions reached, and in doing so, special attention is invited to the Veteran’s lay statements of record. 3. After the above development, and any additionally indicated development, has been completed, readjudicate the issues on appeal. Shereen M. Marcus Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Rachel E. Jensen, 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.