Citation Nr: 21003016 Decision Date: 01/19/21 Archive Date: 01/19/21 DOCKET NO. 13-13 830 DATE: January 19, 2021 REMANDED Entitlement to service connection for a back disability (claimed as back pain) is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1989 to June 1993. This appeal comes to the Board of Veterans’ Appeals (Board) from an April 2012 rating decision of the Department of Veterans Affairs (VA) Regional Office. The case was previously remanded by the Board in November 2016, July 2019, and July 2020. Unfortunately, another remand is required for additional development. In July 2020, the Board remanded this issue in order to obtain an addendum VA medical opinion addressing whether the Veteran’s scoliosis condition and spina bifida conditions were considered a congenital disease or defect and whether any congenital defect or preexisting disability was aggravated by service or a superimposed disability. The VA examiner was specifically asked to discuss whether there was clear and unmistakable evidence that the back disabilities preexisted service and whether it was also clear and unmistakable that they did not increase in severity during service. If either condition was considered a congenital defect, the examiner was asked to opine on whether there was a superimposed injury or disease that as likely as not aggravated the condition in service. The examiner was also asked to discuss the Veteran’s assertions he never had back pain prior to service, but began having back pain and problems in service after being assigned to regularly unload equipment and a July 2013 private opinion which found that the Veteran’s back pain was aggravated by service. An addendum VA medical opinion was obtained in August 2020. It appears that the Board’s previous remand instructions have not been adequately completed, as such remand is required as compliance with prior remand directives is not discretionary. Stegall v. West, 11 Vet. App. 268 (1998). Specifically, the examiner’s report contained several inconsistencies, lacked adequate rationale for the opinions provided, and the examiner failed to discuss the Veteran’s assertions he never had back pain prior to service nor the July 2013 private opinion. Furthermore, the examiner checked the box indicating that scoliosis which clearly and unmistakably existed prior to service, was clearly and unmistakably not aggravated beyond its natural progression. Then, the examiner contradicted himself and wrote that the Veteran’s scoliosis was not present at the time of enlistment, and concluded with a finding that the Veteran’s severe scoliosis is not a congenital disease. The August 2020 report is not probative because it is contradictory and does not take into account the Veteran’s lay statements. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Importantly, the Board notes that the August 2020 examiner did not provide sufficient detail for the Board to fairly adjudicate the claim. As a result of these errors, an additional remand is required. When VA provides an examination or obtains an opinion, the examination or opinion must be adequate. Barr v. Nicholson, 21 Vet. App. 303 (2007). The matters are REMANDED for the following action: Obtain an addendum VA medical opinion from a qualified physician. The examiner is to be provided access to the Veteran’s entire claims file, and must specify in the report that these records have been reviewed. The examiner should then address the following and MUST answer all questions: (a.) If the Veteran’s moderately severe scoliosis is congenital, is the condition a congenital disease OR congenital defect? (b.) If the scoliosis is determined to be a congenital disease, is there i) clear and unmistakable evidence that the disorder preexisted service and ii) clear and unmistakable evidence that the scoliosis did not increase in severity during service? (c.) If the scoliosis is determined to be a congenital defect, did the Veteran incur any superimposed injury or disease in service that as likely as not (50 percent or greater probability) aggravated (caused an increase in severity that is beyond the normal progress of the disease) the defect or the symptoms caused by the defect? (d.) If the Veteran’s spina bifida occulta is congenital, is the condition a congenital disease OR congenital defect? (e.) If spina bifida occulta is determined to be a congenital disease, is there i) clear and unmistakable evidence that the disorder preexisted service and ii) clear and unmistakable evidence that the disorder did not increase in severity during service? (f.) If spina bifida occulta is determined to be a congenital defect, did the Veteran incur any superimposed injury or disease in service that as likely as not aggravated the defect or the symptoms caused by the defect? (g.) Please discuss i) the Veteran’s assertions that he never had back pain prior to service, but began having back pain and problems in service after being assigned to regularly unload equipment weighing up to 200 pounds and ii) the June 2013 private opinion which found that the Veteran’s back pain was aggravated by service. The examiner MUST explain what evidence supports all findings. A complete and fully explanatory rationale must be provided for any opinion offered.  If any opinion cannot be rendered without resorting to speculation, the examiner must provide an explanation for this finding.  If it is found that the Veteran’s lay assertions are not credible, the examiner must explain why Jennifer White Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Mohammad Mahmoudi, 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.