Citation Nr: 21004174 Decision Date: 01/26/21 Archive Date: 01/26/21 DOCKET NO. 11-16 031 DATE: January 26, 2021 REMANDED The claim for service connection for a low back disability and right leg sciatica, to include as secondary to service-connected postoperative right shoulder rotator cuff arthropathy and/or service-connected reflex sympathetic dystrophy and ulnar nerve neuropathy is remanded. REASONS FOR REMAND The Veteran had active service from July 1991 to July 1999. He is seeking service connection for his low back and right leg sciatica. In a July 2015 statement, the Veteran stated that “I’m already service connected for my right shoulder disability as well as the reflex sympathetic dystrophy (RSD) and ulna neuropathy of the right extremity…. my conditions required the implantation of a trans-electrical nerve stimulator in my spine. The battery was located in the thoracolumbar region with wires running through the spine and ending in the electrical leads in the cervic-thoracic spine. Large surgical incisions were required in these areas for the implantation of the device. This procedure was performed at VAMC Durham.” (See 7/21/2015 document entitled “Buddy/Lay Statement”). In an August 2016 statement, the Veteran stated that he had no problems or symptoms until the implanted nerve stimulator procedure at VAMC Durham. The procedure included a battery pack in implanted in his lumbar spine area, with wires running up to and leads fused to his spine. Spasms, pain and limited motion had their onset and existed ever since. (See 8/19/2016 document entitled “Form 9”). VA treatment records show that the Veteran complained about low back pain and right leg pain in December 2007. The physician noted that he had a cervical stimulator placed in 2001 with a battery device located in the right lower back in the lower T-spine region. CT scan in November 2007 showed degenerative disc disease at the level of L4-L5 and L5-S1. Posterior osteophyte of the inferior aspect of L4 may cause symptoms. (See 10/27/2008 document entitled “Medical Treatment Record- Government facility”) A May 2007 VA examination noted that the Veteran had right shoulder surgeries in 1995 and 1997, and he subsequently developed reflex sympathetic dystrophy of the right upper extremity and had a spinal cord nerve stimulator implanted about six years prior. The tip of the nerve stimulator lead was at the level of C7, T1. He had a battery implanted on the back of the lumbar region to the right of midline. The examiner opined that as the tip of the lead was in the lower cervical region, this would not affect the lumbar nerve roots as they were far below the level of the tip of the lead of the nerve stimulator. Therefore, the Veteran’s right sciatica was not secondary to his right shoulder or to the placement of nerve stimulator. (See 5/30/2007 document entitled “VA Examination”). The Veteran argued that the 2007 examiner only considered the fact that the electrical leads were implanted in his neck, but did not consider the numerous years of compression of the subdermal implanted battery pack in his lumbar spine region. (See 11/16/2009 document entitled “NOD”). A May 2017 Board decision remanded the service connection claim for a VA examination and a nexus opinion on whether the Veteran’s back disability (to include right leg sciatica) was related to his service or service-connected right shoulder disability and/or service-connected reflex sympathetic dystrophy and ulnar nerve neuropathy. Specifically, the Board asked the examiner to address the Veteran’s contention that his low back pain and right leg sciatica was related to the implanted battery pack for his implanted neurological stimulator (which was implanted for reflex sympathetic dystrophy). Subsequently, a VA examination was conducted in September 2020 and a VA medical opinion was provided. However, the VA examiner only opined that the Veteran’s right leg sciatica was less likely than not (less than 50 percent probability) caused by his service, or caused or aggravated by his service connected shoulder rotator cuff arthropathy and/or service-connected reflex sympathetic dystrophy and ulnar nerve neuropathy. The examiner indicated that the right leg sciatic was likely related to the degenerative lumbar spine and herniation. However, the examiner did not opine on whether the lumbar spine disability was related to his service or his service-connected right shoulder and/or reflex sympathetic dystrophy and ulnar nerve necrophagy, to include the placement of the battery of the cervical nerve stimulator. (See 9/18/2020 document entitled “C&P Exam”). As such, further development is warranted to investigate the etiology of the Veteran’s back disability and his right leg sciatica. The matters are REMANDED for the following action: Obtain a VA medication opinion on the etiology of the Veteran’s back disability and his right leg sciatica. The examiner should answer the following questions: (a) Is it at least as likely as not (50 percent or greater probability) that the Veteran’s back disability and his right leg sciatica occurred during or was caused by his service? Why or why not? (b) Is it at least as likely as not (50 percent or greater probability) that the Veteran’s back disability and his right leg sciatica was caused by his service-connected right shoulder rotator cuff arthropathy and/or service-connected reflex sympathetic dystrophy and ulnar nerve neuropathy? Why or why not? (c) Is it at least as likely as not (50 percent or greater probability) that the Veteran’s back disability and his right leg sciatica was aggravated (made worse) by his service-connected right shoulder rotator cuff arthropathy and/or service-connected reflex sympathetic dystrophy and ulnar nerve neuropathy? Why or why not? In answering (b) and (c) above, the examiner should address: (1) the Veteran’s July 2015 statement that his low back pain and right leg sciatica was caused by the compression of implanted battery pack for his implanted neurological stimulator, (See 7/21/2015 document entitled “Buddy/Lay Statement”); (2) his August 2016 statement that he had no problems or symptoms until the nerve stimulator and its battery were implanted (See 8/19/2016 document entitled “Form 9”); (3) his November 2009 statement that the 2007 examiner only considered the location of the electrical leads of the stimulator, but did not consider the location of the battery which was in his lumbar spine area. (See 11/16/2009 document entitled “NOD”). MATTHEW W. BLACKWELDER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Q. Wang, 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.