Citation Nr: 21004771 Decision Date: 01/28/21 Archive Date: 01/28/21 DOCKET NO. 13-26 003 DATE: January 28, 2021 REMANDED Entitlement to service connection for a lower back disability secondary to service-connected bilateral knee disability is remanded. INTRODUCTION The Veteran served on active duty from July 1985 to October 2006. He was awarded the combat infantry badge for his honorable service. This matter comes before the Board of Veterans’ Appeals (Board) from an August 2020 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) and was previously remanded by the Board in January 2020. REASONS FOR REMAND While further delay of this appeal is quite regrettable, the Board finds additional development is yet again required before the Veteran's remaining claims are decided. A remand by the Board confers upon the claimant, as a matter of law, the right to compliance with the remand instructions, and imposes upon the VA a concomitant duty to ensure compliance with the terms of the remand. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Unfortunately, there has not been substantial compliance with the Board’s previous January 2020 remand directives. The February 2020 addendum opinion was insufficient because it did not address all theories of entitlement requested by the remand nor provide sufficient reasoning for its conclusions. While noting the Veteran parachuted in service, the examiner did not address it in his opinion. Additionally, the opinion did not provide the right degree of certainty for requested opinions, relying on the legally uncertain term “primary” that the prior remand said was problematic. Finally, the opinion was wholly conclusory. A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. See Nieves- Rodriguez v. Peake, 22 Vet. App. 295 (2008). It also must be stated with the right degree of certainty. See Stefl v. Nicholson, 21 Vet. App. 120 (2007). Further, examiners are not simply free to ignore a veteran's statements related to lay observable symptoms. See Dalton v. Nicholson, 21 Vet. App. 23 (2007). Because there was not substantial compliance, another remand is required. The matters are REMANDED for the following action: 1. Obtain an addendum opinion by a physician with sufficient expertise who has not reviewed the Veteran’s file to address the etiology of the Veteran's claimed back condition. All pertinent evidence of record must be made available to and reviewed by the examiner. A new examination should be performed only if deemed necessary by the examiner. The examiner must state whether it is at least as likely as not (50 percent or greater probability) the Veteran’s lower back disability: a) was due to an event or injury in service, b) was caused by his bilateral knee disabilities, OR c) was worsened to any degree by his bilateral knee disabilities. The examiner must address the Veteran’s credible lay statements about parachuting in service. For all etiological opinions concerning aggravation theory, the examiner should explain whether any baseline changes occurred over time as a result of his service-connected disabilities. The examiner should avoid language describing a condition as being “primary” or “primarily due to” because it confuses the applicable legal standards. Additionally, they should avoid copying and pasting the same text in each section. A complete rationale must be provided for any opinions expressed. If the examiner is unable to provide any required opinion, he or she should explain why. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation as to why this is so. If the inability to provide a more definitive opinion is the result of a need for additional information, the examiner should identify the additional information that is needed. T. REYNOLDS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Rob Schwartz, 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.