Citation Nr: 21004364 Decision Date: 01/26/21 Archive Date: 01/26/21 DOCKET NO. 17-41 021 DATE: January 26, 2021 REMANDED Entitlement to service connection for a back disability is remanded. Entitlement to service connection for radiculopathy of the left lower extremity, to include as secondary to a back disability, is remanded. Entitlement to service connection for radiculopathy of the right lower extremity, to include as secondary to a back disability, is remanded. Entitlement to service connection for a jaw disability, to include temporomandibular joint articulation or bruxism, as secondary to a service-connected disability, is remanded. Entitlement to service connection for irritable bowel syndrome, to include as secondary to a service-connected disability, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Navy from January 2012 to October 2013. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a September 2016 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In July 2020, the Veteran testified before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the claims file. The record was held open for 30 days following the hearing to allow for submission of additional evidence, to include private medical records related to the claims. The Veteran and his representative waived AOJ consideration of such evidence. In July 2020, the VA received additional dental records in connection with the Veteran’s claim. 1. Entitlement to service connection for a back disability is remanded. 2. Entitlement to service connection for radiculopathy of the left lower extremity, to include as secondary to a back disability, is remanded. 3. Entitlement to service connection for radiculopathy of the right lower extremity, to include as secondary to a back disability, is remanded. The Veteran contends that his back disability is related to service. He further contends that his radiculopathy of the bilateral lower extremity is related to service, to include as secondary to a back disability. He testified and the records shows that in November 2012, he was involved in an auto accident wherein he injured his spine, ribs, and sternum. He stated that he sought treatment at a private hospital and underwent rehabilitative treatment. The Veteran underwent a VA examination in August 2016, wherein he was diagnosed with lumbosacral and thoracolumbar strains. The examiner opined that the current condition was less likely than not a continuation of the injury you sustained while in service. The examiner reasoned that service records show a mild back strain sustained in November of 2012 which resolved by the time of your October 2013 separation examination. Further, the examiner stated that the Veteran has not required ongoing treatment for a back condition since that time, and the first time he sought care was in April of 2016, which is several years following the injury. The Board regrets the further delay but finds that a remand is necessary in this appeal to afford the Veteran full consideration. The examiner has not considered the Veteran’s reports multiple fractures to his back and, thus, has not provided a fully complete recitation of the facts. Although the examiner stated that there was no back disability noted upon separation from service or at the time of the accident, the record notes a strain and fractures. Additionally, the Veteran testified that he has continued treatment since service, despite the examiner’s opinion that there was no continuity of care. Upon remand for new examination, the examiner should provide an opinion that considers updated treatment records along with the Veteran’s reports, to include suffering two fractures in the back. The examiner should also opine as to whether radiculopathy of the bilateral lower extremities is present and associated with the back disability. Although the VA examination did not find diagnoses, private treatment records note radicular symptoms. 4. Entitlement to service connection for a jaw disability, to include temporomandibular joint articulation or bruxism, as secondary to a service-connected disability is remanded. The Veteran contends that his jaw disability, to include temporomandibular joint articulation or bruxism, is secondary to his back or rib disability or sleep apnea disorder. The Veteran is service connected for a rib fracture and sleep apnea. He stated that he was diagnosed with TMJ in 2015, approximately two years following discharge. He testified that his doctor indicated that he had bruxism. He stated that he had symptoms of pain, which he believes is due to arthritis medication he was taking at that time. Additionally, he stated that that his sleep apnea has affected his dental disability because he has awoken with blood and a tooth in his mouth. As the current claim requires consideration of whether the back disability is service-connected, the Board finds the claim for a jaw disability to be intertwined with the claim for service connection for back disability. Accordingly, a remand is necessary to determine whether the jaw disability, to include temporomandibular joint articulation or bruxism, is related to service, to include as secondary to his back or the service-connected rib disability or sleep apnea disorder. 5. Entitlement to service connection for irritable bowel syndrome, to include as secondary to a service-connected disability, is remanded. The Veteran contends that his irritable bowel syndrome (IBS) is related to service, to include as secondary to his back disability. The Veteran asserts that his IBS started during service or, alternatively, that it is secondary to his back disability. The Veteran testified that he began experiencing IBS symptoms a few months prior to discharge and following the use of prescription back medication. He testified that while on active duty, symptoms included constant lower abdomen pain, gas, bloating, and difficulty using the restroom. Additionally, he stated that his doctor notified him that Meloxicam, anti-inflammatory arthritis medication prescribed following service, might also have caused some of his conditions. He stated that symptoms have continued since service and he was prescribed omeprazole by the VA to treat his stomach acid. Additionally, September 2016 VA treatment records show IBS symptoms and his overall records are supportive of a possible diagnosis. As the current claim requires consideration of whether the back disability is service-connected, the Board finds the claim for a IBS to be intertwined with the claim for service connection for back disability. As such, a remand is necessary to determine whether the IBS is caused by or aggravated by a service-connected disability, to include rib or back disability, including based on medication. The matters are REMANDED for the following action: 1. Update VA treatment records. 2. Thereafter, schedule the Veteran for an examination with an appropriate clinician to determine the nature and etiology of his back condition. The examiner should opine on the following: Is it at least as likely as not (50 percent or greater probability) that the Veteran’s back disability is related to his service? The examiner should address the Veteran’s reports and the records showing fractures and continued treatment. In providing the requested opinion, the examiner must fully consider the Veteran’s statements. 3. After completing directive #1, schedule the Veteran for an examination with an appropriate clinician to determine the nature and etiology of any radiculopathy of his bilateral lower extremities. The examiner should opine on the following: a) Does the Veteran have radiculopathy of the bilateral lower extremities? b) If so, is it at least as likely as not (50 percent or greater probability) that the Veteran’s radiculopathy of the bilateral lower extremities is related to service? c) Is it at least as likely as not (50 percent or greater probability) that the Veteran’s radiculopathy of the bilateral lower extremities is proximately due to or caused by his back disability? d) Is it at least as likely as not (50 percent or greater probability) that the Veteran’s radiculopathy of the bilateral lower extremities is aggravated beyond its normal progression by his back disability? 4. After completing directive #1, schedule the Veteran for an examination with an appropriate clinician to determine the nature and etiology of his jaw disability. The examiner should opine on the following: a) What are the current diagnoses of jaw disability? Does the Veteran have TMJ and/or bruxism? b) For each diagnosis, is it at least as likely as not (50 percent or greater probability) that such disability is proximately due to, caused, or aggravated beyond natural progression by his service-connected sleep apnea and/or residuals of rib fracture? Or in the alternative, is such disability proximately due to, caused, or aggravated beyond natural progression by a back disability, to include based on prescription medication? 5. After completing directive #1, schedule the Veteran for an examination with an appropriate clinician to determine the nature and etiology of his irritable bowel syndrome. The examiner should opine on the following: a) Does the Veteran have irritable bowel syndrome? b) If so, is it at least as likely as not (50 percent or greater probability) that his IBS is related to service? c) If there is an IBS diagnosis, it at least as likely as not (50 percent or greater probability) that it is proximately due to, caused, or aggravated beyond natural progression by his service-connected sleep apnea and/or residuals of rib fracture? Or in the alternative, is such disability proximately due to, caused, or aggravated beyond natural progression by a back disability, to include based on prescription medication? Nathaniel J. Doan Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Wilson, 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.