Citation Nr: 21061535 Decision Date: 10/04/21 Archive Date: 10/04/21 DOCKET NO. 13-22 650 DATE: October 4, 2021 REMANDED Entitlement to service connection for a cervical spine disability is remanded. REASONS FOR REMAND The appellant is a Veteran who served on active duty from May 1962 to May 1969. This matter is before the Board of Veterans' Appeals (Board) on appeal from a November 2011 rating decision. In December 2016, a videoconference hearing was held before the undersigned; a transcript of the hearing is in the record. In September 2017 and September 2019, the case was remanded for further development. In a July 2013 a private provider, Dr. M, opined that the Veteran's cervical spine disability was more likely than not related to his military service. The opinion is inadequate for rating purposes because it does not reflect knowledge of the Veteran's actual records; the opinion is essentially based on self-reported history; and the rationale is conclusory (lacks adequate explanation of rationale). In May 2015 a VA provider opined that it is less likely than not that a cervical spine disability is related to service or a low back disability. That opinion is inadequate for rating purposes because it focuses mainly on causation and does not address aggravation (as a secondary service connection theory of entitlement). At the December 2016 videoconference hearing the Veteran reiterated his alternate theory of entitlement (that his cervical spine disability is secondary to his service-connected low back disability). In February 2019, a VA provider opined that it is less likely than not that the Veteran's cervical spine disability is related to his service. This opinion is inadequate because it does not address the alleged secondary service connection theory of entitlement. In September 2019, the Board sought development for a fully adequate medical advisory opinion. In an August 2021 VA opinion, the examiner opined that the Veteran's cervical spine disability is less likely than not incurred in service. She explained that review of all the evidence pertaining to the examination, to include service treatment records (STRs) and post service medical records, did not find that the Veteran complained of, or was treated for, a cervical spine disorder during service. It was noted that the first documented treatment for the cervical spine was on March 12, 1994, by chiropractor, Dr. M, and that April 1994 cervical spine X-rays showed C5-C6 degenerative joint disease (DJD) and osteophytes at C5, C6, and C7. She observed that this was 25 years after the Veteran's separation from service, when he was 49 years old, and according to the National Institute on Aging, osteoarthritis can occur in men before the age of 45. Additionally, a 2009 cervical spine MRI showed multilevel degenerative changes and degenerative disc disease (DDD) and a 2010 MRI showed cervical spine spondylosis with bony hypertrophy and mild degenerative neural foraminal stenosis. She noted that by then, the Veteran was 65 years old and had cervical spine progressive DJD and DDD, which is more related to aging and normal wear and tear on the vertebra of the cervical spine. In an August 2021 addendum opinion, the examiner opined that it was less likely than not that the Veteran's service-connected low back disability caused or aggravated his cervical spine disability. She noted that the disabilities involve two separate areas of the spine, the first documented cervical spine complaint post service was in March of 1994, and the Veteran's lumbar spine disability was recognized and treated during service in the 1960s, (a 34-year duration between these diagnoses); also, based on the Veteran's age at the time of his cervical spine diagnosis, and medical literature regarding causes and age of onset of osteoarthritis, it was very likely that his cervical spine disability was age-related only. She explained that injury to one segment of the spine does not cause injury to another area of the spine, nor does it cause osteoarthritis to occur in a different area of the spine. She opined that although the severity of the Veteran's cervical spine disability was greater than baseline, it was not aggravated beyond natural progression, and that such progression of the cervical spine (osteoarthritis) disability was due to his advancing age. The Board finds that the August 2021 opinion (and addendum) are inadequate for rating purposes. The examiner noted that the Veteran's first documented treatment for his cervical spine (in the record) was by the chiropractor, Dr. M, on March 12, 1994. Private treatment records received by VA in November 2017 do note that the Veteran received treatment after a motor vehicle accident (MVA) in March 1994. However, other treatment records from Dr. M. also received in November 2017, note that the Veteran sought treatment for neck pain beginning in March 1989 [emphasis added] and was seen for neck and back pain on an intermittent basis from then until March 1994 (and for many years thereafter). Therefore, the opinion and addendum opinion are based on an inaccurate factual premise, and remand to obtain an addendum medical opinion that considers the accurate record is necessary. The matter is REMANDED for the following: Arrange for the Veteran's record to be returned to the August 2021 VA consulting provider for re-review and an addendum medical opinion regarding the likely etiology of his cervical spine disability, and specifically whether it was caused or aggravated by his service-connected low back disability. [If the August 2021 consulting provider is unavailable or unable to provide the addendum opinion sought, the record should be forwarded to another appropriate clinician for review and the opinion sought.] The examiner must review the entire record and provide responses to the following: (a) Identify (by diagnosis) each cervical spine disability entity found and identify the likely etiology of each cervical spine disability entity diagnosed. Specifically, is it at least as likely as not (a 50 % or better probability) that it was caused or aggravated by (increased in severity due to) the Veteran's service-connected low back disability? [The opinion must address aggravation.] (b) If the service-connected low back disability did not cause, but aggravated, a cervical spine disability, specify, to the extent possible, the degree of disability (pathology or impairment) that has resulted from such aggravation. (c) If a diagnosed cervical spine disability is found to not have been caused or aggravated by the service-connected low back disability, identify the etiology considered to be more likely (and explain why that is so). The consulting provider should include rationale with all opinions, to include discussion of the significance (if any) of the private treatment records received by VA in November 2017 that note chiropractic treatment for neck pain from March 1989 to March 1994. GEORGE R. SENYK Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Bayles, 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.